Surgical instruments with articulating shafts

ABSTRACT

Various embodiments are directed to articulatable surgical instruments. Some embodiments comprise an end effector to treat tissue, where the end effector comprises an ultrasonic blade. A hollow shaft may extend proximally from the end effector along a longitudinal axis. A waveguide may extend through the shaft and may be acoustically coupled to the ultrasonic blade. The waveguide may comprise a distally positioned flange positioned within the hollow shaft proximally from the blade and may be held stationary at a first pivot point positioned within the hollow shaft proximally from the flange. A reciprocating wedge may be positioned within the hollow shaft such that distal motion of the wedge pushes the wedge between the flange and the hollow shaft, causing the ultrasonic blade to pivot about the first pivot point in a first direction.

CROSS-REFERENCE TO RELATED APPLICATIONS

U.S. application Ser. No. 13/539,096, entitled “Haptic Feedback Devicesfor Surgical Robot,” now U.S. Patent Application Publication No.2014/0005682;

U.S. application Ser. No. 13/539,110, entitled “Lockout Mechanism forUse with Robotic Electrosurgical Device,” now U.S. Patent ApplicationPublication No. 2014/0005654;

U.S. application Ser. No. 13/539,117, entitled “Closed Feedback Controlfor Electrosurgical Device,” now U.S. Patent Application Publication No.2014/0005667;

U.S. application Ser. No. 13/538,588, entitled “Surgical Instrumentswith Articulating Shafts,” now U.S. Patent Application Publication No.2014/0005701;

U.S. application Ser. No. 13/538,601, entitled “Ultrasonic SurgicalInstruments with Distally Positioned Transducers,” now U.S. PatentApplication Publication No. 2014/0005702;

U.S. application Ser. No. 13/538,711, entitled “Ultrasonic SurgicalInstruments with Distally Positioned Jaw Assemblies,” now U.S. PatentApplication Publication No. 2014/0005704;

U.S. application Ser. No. 13/538,720, entitled “Surgical Instrumentswith Articulating Shafts,” now U.S. Patent Application Publication No.2014/0005705;

U.S. application Ser. No. 13/538,733, entitled “Ultrasonic SurgicalInstruments with Control Mechanisms,” now U.S. Patent ApplicationPublication No. 2014/0005681; and

U.S. application Ser. No. 13/539,122, entitled “Surgical InstrumentsWith Fluid Management System, ” now U.S. Patent Application PublicationNo. 2014/0005668.

BACKGROUND

Various embodiments are directed to surgical devices, including variousarticulatable shafts and ultrasonic blades for use with surgicaldevices.

Ultrasonic surgical devices, such as ultrasonic scalpels, are used inmany applications in surgical procedures by virtue of their uniqueperformance characteristics. Depending upon specific deviceconfigurations and operational parameters, ultrasonic surgical devicescan provide substantially simultaneous transection of tissue andhomeostasis by coagulation, desirably minimizing patient trauma. Anultrasonic surgical device comprises a proximally-positioned ultrasonictransducer and an instrument coupled to the ultrasonic transducer havinga distally-mounted end effector comprising an ultrasonic blade to cutand seal tissue. The end effector is typically coupled either to ahandle and/or a robotic surgical implement via a shaft. The blade isacoustically coupled to the transducer via a waveguide extending throughthe shaft. Ultrasonic surgical devices of this nature can be configuredfor open surgical use, laparoscopic, or endoscopic surgical proceduresincluding robotic-assisted procedures.

Ultrasonic energy cuts and coagulates tissue using temperatures lowerthan those used in electrosurgical procedures. Vibrating at highfrequencies (e.g., 55,500 times per second), the ultrasonic bladedenatures protein in the tissue to form a sticky coagulum. Pressureexerted on tissue by the blade surface collapses blood vessels andallows the coagulum to form a hemostatic seal. A surgeon can control thecutting speed and coagulation by the force applied to the tissue by theend effector, the time over which the force is applied and the selectedexcursion level of the end effector.

Also used in many surgical applications are electrosurgical devices.Electrosurgical devices apply electrical energy to tissue in order totreat tissue. An electrosurgical device may comprise an instrumenthaving a distally-mounted end effector comprising one or moreelectrodes. The end effector can be positioned against tissue such thatelectrical current is introduced into the tissue. Electrosurgicaldevices can be configured for bipolar or monopolar operation. Duringbipolar operation, current is introduced into and returned from thetissue by active and return electrodes, respectively, of the endeffector. During monopolar operation, current is introduced into thetissue by an active electrode of the end effector and returned through areturn electrode (e.g., a grounding pad) separately located on apatient's body. Heat generated by the current flow through the tissuemay form haemostatic seals within the tissue and/or between tissues andthus may be particularly useful for sealing blood vessels, for example.The end effector of an electrosurgical device sometimes also comprises acutting member that is movable relative to the tissue and the electrodesto transect the tissue.

Electrical energy applied by an electrosurgical device can betransmitted to the instrument by a generator. The electrical energy maybe in the form of radio frequency (“RF”) energy. RF energy is a form ofelectrical energy that may be in the frequency range of 300 kHz to 1MHz. During its operation, an electrosurgical device can transmit lowfrequency RF energy through tissue, which causes ionic agitation, orfriction, in effect resistive heating, thereby increasing thetemperature of the tissue. Because a sharp boundary may be createdbetween the affected tissue and the surrounding tissue, surgeons canoperate with a high level of precision and control, without sacrificingun-targeted adjacent tissue. The low operating temperatures of RF energymay be useful for removing, shrinking, or sculpting soft tissue whilesimultaneously sealing blood vessels. RF energy may work particularlywell on connective tissue, which is primarily comprised of collagen andshrinks when contacted by heat.

With respect to both ultrasonic and electrosurgical devices, it is oftendesirable for clinicians to articulate a distal portion of theinstrument shaft in order to direct the application of ultrasonic and/orRF energy. Bringing about and controlling such articulation, however, isoften a considerable challenge.

DRAWINGS

The features of the various embodiments are set forth with particularityin the appended claims. The various embodiments, however, both as toorganization and methods of operation, together with advantages thereof,may best be understood by reference to the following description, takenin conjunction with the accompanying drawings as follows:

FIG. 1 illustrates one embodiment of a surgical system including asurgical instrument and an ultrasonic generator.

FIG. 2 illustrates one embodiment of the surgical instrument shown inFIG. 1.

FIG. 3 illustrates one embodiment of an ultrasonic end effector.

FIG. 4 illustrates another embodiment of an ultrasonic end effector.

FIG. 5 illustrates an exploded view of one embodiment of the surgicalinstrument shown in FIG. 1.

FIG. 6 illustrates a cut-away view of one embodiment of the surgicalinstrument shown in FIG. 1.

FIG. 7 illustrates various internal components of one embodiment of thesurgical instrument shown in FIG. 1

FIG. 8 illustrates a top view of one embodiment of a surgical systemincluding a surgical instrument and an ultrasonic generator.

FIG. 9 illustrates one embodiment of a rotation assembly included in oneexample embodiment of the surgical instrument of FIG. 1.

FIG. 10 illustrates one embodiment of a surgical system including asurgical instrument having a single element end effector.

FIG. 11 is a perspective view of one embodiment of an electrical energysurgical instrument.

FIG. 12 is a side view of a handle of one embodiment of the surgicalinstrument of FIG. 11 with a half of a handle body removed to illustratesome of the components therein.

FIG. 13 illustrates a perspective view of one embodiment of the endeffector of the surgical instrument of FIG. 11 with the jaws open andthe distal end of an axially movable member in a retracted position.

FIG. 14 illustrates a perspective view of one embodiment of the endeffector of the surgical instrument of FIG. 11 with the jaws closed andthe distal end of an axially movable member in a partially advancedposition.

FIG. 15 illustrates a perspective view of one embodiment of the axiallymoveable member of the surgical instrument of FIG. 11.

FIG. 16 illustrates a section view of one embodiment of the end effectorof the surgical instrument of FIG. 11.

FIG. 17 illustrates a section a perspective view of one embodiment of acordless electrical energy surgical instrument.

FIG. 18A illustrates a side view of a handle of one embodiment of thesurgical instrument of FIG. 17 with a half handle body removed toillustrate various components therein.

FIG. 18B illustrates an RF drive and control circuit, according to oneembodiment.

FIG. 18C illustrates the main components of the controller, according toone embodiment.

FIG. 19 illustrates a block diagram of one embodiment of a roboticsurgical system.

FIG. 20 illustrates one embodiment of a robotic arm cart.

FIG. 21 illustrates one embodiment of the robotic manipulator of therobotic arm cart of FIG. 20.

FIG. 22 illustrates one embodiment of a robotic arm cart having analternative set-up joint structure.

FIG. 23 illustrates one embodiment of a controller that may be used inconjunction with a robotic arm cart, such as the robotic arm carts ofFIGS. 19-22.

FIG. 24 illustrates one embodiment of an ultrasonic surgical instrumentadapted for use with a robotic system.

FIG. 25 illustrates one embodiment of an electrosurgical instrumentadapted for use with a robotic system.

FIG. 26 illustrates one embodiment of an instrument drive assembly thatmay be coupled to a surgical manipulator to receive and control thesurgical instrument shown in FIG. 24.

FIG. 27 illustrates another view of the instrument drive assemblyembodiment of FIG. 26 including the surgical instrument of FIG. 24.

FIG. 28 illustrates another view of the instrument drive assembly ofFIG. 26 including the electrosurgical instrument of FIG. 25.

FIGS. 29-31 illustrate additional views of the adapter portion of theinstrument drive assembly embodiment of FIG. 26.

FIGS. 32-34 illustrate one embodiment of the instrument mounting portionof FIGS. 24-25 showing components for translating motion of the drivenelements into motion of the surgical instrument.

FIGS. 35-37 illustrate an alternate embodiment of the instrumentmounting portion of FIGS. 24-25 showing an alternate example mechanismfor translating rotation of the driven elements into rotational motionabout the axis of the shaft and an alternate example mechanism forgenerating reciprocating translation of one or more members along theaxis of the shaft 538.

FIGS. 38-42 illustrate an alternate embodiment of the instrumentmounting portion FIGS. 24-25 showing another alternate example mechanismfor translating rotation of the driven elements into rotational motionabout the axis of the shaft.

FIGS. 43-46A illustrate an alternate embodiment of the instrumentmounting portion showing an alternate example mechanism for differentialtranslation of members along the axis of the shaft (e.g., forarticulation).

FIGS. 46B-46C illustrate one embodiment of a tool mounting portioncomprising internal power and energy sources.

FIG. 47 illustrates a schematic cross-sectional view of a portion of oneexample embodiment of an ultrasonic medical instrument comprising first,second and third waveguide portions, where the second waveguide portionis substantially ½ of a resonant-longitudinal-wavelength long.

FIG. 47A illustrates cross sections for two example embodiments of thesecond waveguide portion of FIG. 47.

FIG. 48 illustrates a schematic cross-sectional view of a portion of oneexample embodiment of an ultrasonic medical instrument comprising firstand second waveguide portions, where the first waveguide portion spansmultiple ½ resonant longitudinal wavelengths.

FIG. 49 illustrates a schematic cross-sectional view of one exampleembodiment of an ultrasonic waveguide for use with a medical instrumentand comprising first and second waveguide portions, where a firstwaveguide portion is joined to a second waveguide portion by a dowelpress fit.

FIG. 50 illustrates a schematic cross-sectional view of one exampleembodiment of an ultrasonic waveguide for use with a medical instrumentand comprising first and second waveguide portions, where the firstwaveguide portion is joined to the second waveguide portion by aball-and-socket type attachment.

FIG. 51 illustrates a schematic cross-sectional view of a portion ofanother embodiment of an ultrasonic medical instrument comprising amedical ultrasonic waveguide having a length and including a proximalwaveguide portion and a distal waveguide portion.

FIG. 52 illustrates one embodiment of a shaft that may be utilized withvarious surgical instruments, including those described herein.

FIG. 53 illustrates one embodiment of the shaft of FIG. 52 with thewedge translated distally and the blade pivoted, as described.

FIG. 54 illustrates an alternative embodiment of the shaft of FIG. 52comprising several additional features.

FIG. 55 illustrates one embodiment of an example wedge having a curvedor rounded shape.

FIG. 56 illustrates the wedge in conjunction with an end effectorcomprising an ultrasonic blade as well as a flange.

FIG. 57 illustrates a cross-section of one embodiment of the shaftshowing a keyed flange.

FIG. 58 illustrates one embodiment of a keyed wedge comprising stepsmatching the notches of the keyed flange of FIG. 57.

FIG. 59 illustrates a wedge for use with the shaft, the wedge having astepped profile.

FIG. 60 illustrates one example embodiment of a shaft for use withvarious surgical instruments having a cammed articulation mechanism,including those described herein.

FIG. 61 illustrates a cross-sectional view of the shaft of FIG. 60providing a view of the shaft cam feature and waveguide cam feature.

FIG. 62-64 illustrates one embodiment of an articulating shaft that maybe utilized with various surgical instruments, including those describedherein.

FIGS. 65-67 illustrate one example embodiment of a shaft coupled to anend effector comprising an ultrasonic blade and a pivotable clamp arm.

FIG. 68 illustrates one embodiment of the end effector of FIGS. 65-67illustrating a first way to utilize the clamp arm member to open andclose the clamp arm.

FIGS. 69-70 illustrate another example embodiment of the end effector ofFIGS. 65-67 illustrating an additional way to utilize the clamp armmember to open and close the clamp arm.

FIGS. 71-72 illustrate one example embodiment of the shaft of FIGS.65-67 showing an example mechanism for managing differential translationof the translating members.

FIGS. 73-74 illustrate one embodiment of a hand-held surgical instrumentutilizing the shaft of FIGS. 65-67 in the configuration shown in FIGS.71-72.

FIGS. 75-76 illustrate one embodiment of an articulating shaft that maybe utilized with various surgical instruments, including those describedherein.

FIG. 77 illustrates one embodiment of a shaft that may be utilized withvarious surgical instruments, including those described herein.

FIG. 78 illustrates a view showing additional details of one embodimentof an outer shaft shown in FIG. 77.

FIG. 79 illustrates a cut-away view of one embodiment of the shaft shownin FIG. 77.

FIG. 80 illustrates the cut-away view of one embodiment of the shaft ofFIG. 79, with the outer shaft extended distally to articulate the blade.

FIG. 81 illustrates one embodiment of the shaft of FIG. 77 having anadditional distal flange.

DESCRIPTION

Example embodiments described herein are directed to articulatingsurgical instruments, shafts thereof, and methods of using the same. Thesurgical instruments may comprise an end effector configured to treattissue in any suitable manner. In some example embodiments, the endeffector comprises an ultrasonic blade for cutting and/or coagulatingtissue. Details of example ultrasonic blades and the operation thereofare provided herein. Also, in some example embodiments, the end effectorcan comprise one or more electrodes for providing electrical energy totissue for cutting, coagulating and/or “welding” tissue. Surgicalinstruments described herein may be utilized in different surgicalsettings. For example, different embodiments may be optimized forendoscopic, laparoscopic and/or traditional open surgical techniques.Also, different example embodiments of the surgical instrumentsdescribed herein may be optimized for manual use by a clinician and/orfor robotic use by a clinician in conjunction with a surgical robot.

Various example embodiments of surgical instruments described hereincomprise an elongated shaft extending proximally from the end effectoralong a longitudinal axis. In some example embodiments, the end effectorcomprises an ultrasonic blade that may be articulated and/or directedfrom within the shaft (e.g., without otherwise articulating the shaft orin addition to otherwise articulating the shaft). For example, in someexample embodiments, the ultrasonic blade is acoustically coupled to awaveguide extending proximally from the ultrasonic blade through theshaft. The waveguide may define a distally positioned flange positionedwithin the hollow shaft proximally from the blade. The waveguide mayfurther be held stationary at a first pivot point positioned within theshaft proximally from the flange. A reciprocating wedge may bepositioned to reciprocate distally and proximally within the shaft.Distal translation of the wedge may push the wedge between the flangeand an interior wall of the shaft, ending to cause the ultrasonic bladeand waveguide to pivot away from a longitudinal axis of the shaft aboutthe first pivot point. Additional wedges may be placed at differentangular positions around the interior wall of the shaft so as toarticulate the ultrasonic blade in different directions.

In some example embodiments, an interior wall of the shaft defines alongitudinally directed slot and at least a portion of the reciprocatingwedge is positioned within the longitudinal slot as the wedge translatesdistally and proximally. Also, in some example embodiments, the wedgeand flange have corresponding keyed surfaces. For example, the flangemay define a notch and the wedge may define a corresponding step suchthat the step rides within the notch as the reciprocating wedge istranslated distally. Additional notches and wedges may also be presentand, in some example embodiments, form a step pattern. In some exampleembodiments, the reciprocating wedge may be stepped, where steps arearranged along the longitudinal axis such that successive steps of thewedge cause the ultrasonic blade and waveguide to pivot about the pivotpoint by differing amounts.

In some example embodiments, the shaft is translatable along thelongitudinal axis relative to the waveguide and ultrasonic blade. Forexample, the shaft may define first and second axially-directed slots,wherein the flange of the waveguide comprises first and second pegspositioned within the first and second slots. The shaft may betranslatable relative to the ultrasonic blade to alternately sheathe andunsheathe the blade.

In some example embodiments, an interior portion of the hollow shaftdefines a shaft cam feature directed towards the longitudinal axis. Theshaft may be rotatable such that the shaft cam alternately contacts anddoes not contact the flange of the waveguide. In some embodiments, theflange of the waveguide has a corresponding cam feature. When the camfeature contacts the flange, it may cause the waveguide and ultrasonicblade to pivot about the pivot point. In various example embodiments,multiple surface cam features and/or multiple cam features on the flangemay be utilized to bring about pivoting of the ultrasonic blade andwaveguide in different directions.

In various example embodiments, the interior wall of the shaft defines agroove. Different portions of the groove are positioned at differentaxial distances from the end effector. The instrument may furthercomprise first and second interface members coupled to the ultrasonicblade and/or the waveguide at a coupling point. Each interface memberextends proximally from the coupling point to a peg member. The pegmembers are positioned within the groove. The first interface member hasa first length from the coupling point to its peg member while thesecond interface member has a second length from the coupling point toits peg member, where the second length is less than the first length.When the shaft rotates relative to the waveguide and ultrasonic blade,the pegs may ride within the groove and be forced either distally and/orproximally depending on the position of the pegs within the groove. Whenthe distance from the pegs to the coupling point is different than thelength of the respective coupling members, the coupling members maybend, deflecting the ultrasonic blade away from the longitudinal axis.

In various example embodiments, a surgical instrument may comprise anend effector with an ultrasonic blade, a hollow shaft and a waveguide.The shaft may comprise a rigid portion and a flexible portion. The endeffector may comprises a member from which the ultrasonic blade extends,a clamp arm coupled to the member at a pivot point offset from thelongitudinal axis and a flexible control cable coupled to the clamp armat a point offset from the pivot point. Distal and proximal translationof the control cable may cause the clamp arm to pivot relative to theultrasonic blade.

Reference will now be made in detail to several embodiments, includingembodiments showing example implementations of manual and roboticsurgical instruments with end effectors comprising ultrasonic and/orelectrosurgical elements. Wherever practicable similar or like referencenumbers may be used in the figures and may indicate similar or likefunctionality. The figures depict example embodiments of the disclosedsurgical instruments and/or methods of use for purposes of illustrationonly. One skilled in the art will readily recognize from the followingdescription that alternative example embodiments of the structures andmethods illustrated herein may be employed without departing from theprinciples described herein.

FIG. 1 is a right side view of one embodiment of an ultrasonic surgicalinstrument 10. In the illustrated embodiment, the ultrasonic surgicalinstrument 10 may be employed in various surgical procedures includingendoscopic or traditional open surgical procedures. In one exampleembodiment, the ultrasonic surgical instrument 10 comprises a handleassembly 12, an elongated shaft assembly 14, and an ultrasonictransducer 16. The handle assembly 12 comprises a trigger assembly 24, adistal rotation assembly 13, and a switch assembly 28. The elongatedshaft assembly 14 comprises an end effector assembly 26, which compriseselements to dissect tissue or mutually grasp, cut, and coagulate vesselsand/or tissue, and actuating elements to actuate the end effectorassembly 26. The handle assembly 12 is adapted to receive the ultrasonictransducer 16 at the proximal end. The ultrasonic transducer 16 ismechanically engaged to the elongated shaft assembly 14 and portions ofthe end effector assembly 26. The ultrasonic transducer 16 iselectrically coupled to a generator 20 via a cable 22. Although themajority of the drawings depict a multiple end effector assembly 26 foruse in connection with laparoscopic surgical procedures, the ultrasonicsurgical instrument 10 may be employed in more traditional open surgicalprocedures and in other embodiments, may be configured for use inendoscopic procedures and in other embodiments, may be configured foruse in endoscopic procedures. For the purposes herein, the ultrasonicsurgical instrument 10 is described in terms of an endoscopicinstrument; however, it is contemplated that an open and/or laparoscopicversion of the ultrasonic surgical instrument 10 also may include thesame or similar operating components and features as described herein.

In various embodiments, the generator 20 comprises several functionalelements, such as modules and/or blocks. Different functional elementsor modules may be configured for driving different kinds of surgicaldevices. For example, an ultrasonic generator module 21 may drive anultrasonic device, such as the ultrasonic surgical instrument 10. Insome example embodiments, the generator 20 also comprises anelectrosurgery/RF generator module 23 for driving an electrosurgicaldevice (or an electrosurgical embodiment of the ultrasonic surgicalinstrument 10). In various embodiments, the generator 20 may be formedintegrally within the handle assembly 12. In such implementations, abattery would be co-located within the handle assembly 12 to act as theenergy source. FIG. 18A and accompanying disclosures provide one exampleof such implementations. As shown in FIG. 1, according to variousembodiments, the ultrasonic generator module 21 and/or theelectrosurgery/RF generator module 23 may be located external to thegenerator (shown in phantom as ultrasonic generator module 21′ andelectrosurgery/RF generator module 23′). In some embodiments, theelectrosurgery/RF generator module 23 may be configured to generate atherapeutic and/or a sub-therapeutic energy level. In the exampleembodiment illustrated in FIG. 1, the generator 20 includes a controlsystem 25 integral with the generator 20, and a foot switch 29 connectedto the generator via a cable 27. The generator 20 may also comprise atriggering mechanism for activating a surgical instrument, such as theinstrument 10. The triggering mechanism may include a power switch (notshown) as well as a foot switch 29. When activated by the foot switch29, the generator 20 may provide energy to drive the acoustic assemblyof the surgical instrument 10 and to drive the end effector 18 at apredetermined excursion level. The generator 20 drives or excites theacoustic assembly at any suitable resonant frequency of the acousticassembly and/or derives the therapeutic/sub-therapeuticelectromagnetic/RF energy.

In one embodiment, the electrosurgical/RF generator module 23 may beimplemented as an electrosurgery unit (ESU) capable of supplying powersufficient to perform bipolar electrosurgery using radio frequency (RF)energy. In one embodiment, the ESU can be a bipolar ERBE ICC 350 sold byERBE USA, Inc. of Marietta, Ga. In bipolar electrosurgery applications,as previously discussed, a surgical instrument having an activeelectrode and a return electrode can be utilized, wherein the activeelectrode and the return electrode can be positioned against, oradjacent to, the tissue to be treated such that current can flow fromthe active electrode to the return electrode through the tissue.Accordingly, the electrosurgical/RF module 23 generator may beconfigured for therapeutic purposes by applying electrical energy to thetissue T sufficient for treating the tissue (e.g., cauterization).

In one embodiment, the electrosurgical/RF generator module 23 may beconfigured to deliver a sub-therapeutic RF signal to implement a tissueimpedance measurement module. In one embodiment, the electrosurgical/RFgenerator module 23 comprises a bipolar radio frequency generator asdescribed in more detail below. In one embodiment, theelectrosurgical/RF generator module 23 may be configured to monitorelectrical impedance Z, of tissue T and to control the characteristicsof time and power level based on the tissue T by way of a returnelectrode provided on a clamp member of the end effector assembly 26.Accordingly, the electrosurgical/RF generator module 23 may beconfigured for sub-therapeutic purposes for measuring the impedance orother electrical characteristics of the tissue T. Techniques and circuitconfigurations for measuring the impedance or other electricalcharacteristics of tissue T are discussed in more detail in commonlyassigned U.S. Patent Publication No. 2011/0015631, titled“Electrosurgical Generator for Ultrasonic Surgical Instruments,” thedisclosure of which is herein incorporated by reference in its entirety.

A suitable ultrasonic generator module 21 may be configured tofunctionally operate in a manner similar to the GEN300 sold by EthiconEndo-Surgery, Inc. of Cincinnati, Ohio as is disclosed in one or more ofthe following U.S. patents, all of which are incorporated by referenceherein: U.S. Pat. No. 6,480,796 (Method for Improving the Start Up of anUltrasonic System Under Zero Load Conditions); U.S. Pat. No. 6,537,291(Method for Detecting Blade Breakage Using Rate and/or ImpedanceInformation); U.S. Pat. No. 6,662,127 (Method for Detecting Presence ofa Blade in an Ultrasonic System); U.S. Pat. No. 6,679,899 (Method forDetecting Transverse Vibrations in an Ultrasonic Hand Piece); U.S. Pat.No. 6,977,495 (Detection Circuitry for Surgical Handpiece System); U.S.Pat. No. 7,077,853 (Method for Calculating Transducer Capacitance toDetermine Transducer Temperature); U.S. Pat. No. 7,179,271 (Method forDriving an Ultrasonic System to Improve Acquisition of Blade ResonanceFrequency at Startup); and U.S. Pat. No. 7,273,483 (Apparatus and Methodfor Alerting Generator Function in an Ultrasonic Surgical System).

It will be appreciated that in various embodiments, the generator 20 maybe configured to operate in several modes. In one mode, the generator 20may be configured such that the ultrasonic generator module 21 and theelectrosurgical/RF generator module 23 may be operated independently.

For example, the ultrasonic generator module 21 may be activated toapply ultrasonic energy to the end effector assembly 26 andsubsequently, either therapeutic or sub-therapeutic RF energy may beapplied to the end effector assembly 26 by the electrosurgical/RFgenerator module 23. As previously discussed, the sub-therapeuticelectrosurgical/RF energy may be applied to tissue clamped between claimelements of the end effector assembly 26 to measure tissue impedance tocontrol the activation, or modify the activation, of the ultrasonicgenerator module 21. Tissue impedance feedback from the application ofthe sub-therapeutic energy also may be employed to activate atherapeutic level of the electrosurgical/RF generator module 23 to sealthe tissue (e.g., vessel) clamped between claim elements of the endeffector assembly 26.

In another embodiment, the ultrasonic generator module 21 and theelectrosurgical/RF generator module 23 may be activated simultaneously.In one example, the ultrasonic generator module 21 is simultaneouslyactivated with a sub-therapeutic RF energy level to measure tissueimpedance simultaneously while the ultrasonic blade of the end effectorassembly 26 cuts and coagulates the tissue (or vessel) clamped betweenthe clamp elements of the end effector assembly 26. Such feedback may beemployed, for example, to modify the drive output of the ultrasonicgenerator module 21. In another example, the ultrasonic generator module21 may be driven simultaneously with electrosurgical/RF generator module23 such that the ultrasonic blade portion of the end effector assembly26 is employed for cutting the damaged tissue while theelectrosurgical/RF energy is applied to electrode portions of the endeffector clamp assembly 26 for sealing the tissue (or vessel).

When the generator 20 is activated via the triggering mechanism,electrical energy is continuously applied by the generator 20 to atransducer stack or assembly of the acoustic assembly. In anotherembodiment, electrical energy is intermittently applied (e.g., pulsed)by the generator 20. A phase-locked loop in the control system of thegenerator 20 may monitor feedback from the acoustic assembly. The phaselock loop adjusts the frequency of the electrical energy sent by thegenerator 20 to match the resonant frequency of the selectedlongitudinal mode of vibration of the acoustic assembly. In addition, asecond feedback loop in the control system 25 maintains the electricalcurrent supplied to the acoustic assembly at a pre-selected constantlevel in order to achieve substantially constant excursion at the endeffector 18 of the acoustic assembly. In yet another embodiment, a thirdfeedback loop in the control system 25 monitors impedance betweenelectrodes located in the end effector assembly 26. Although FIGS. 1-9show a manually operated ultrasonic surgical instrument, it will beappreciated that ultrasonic surgical instruments may also be used inrobotic applications, for example, as described herein, as well ascombinations of manual and robotic applications.

In ultrasonic operation mode, the electrical signal supplied to theacoustic assembly may cause the distal end of the end effector 18, tovibrate longitudinally in the range of, for example, approximately 20kHz to 250 kHz. According to various embodiments, the blade 22 mayvibrate in the range of about 54 kHz to 56 kHz, for example, at about55.5 kHz. In other embodiments, the blade 22 may vibrate at otherfrequencies including, for example, about 31 kHz or about 80 kHz. Theexcursion of the vibrations at the blade can be controlled by, forexample, controlling the amplitude of the electrical signal applied tothe transducer assembly of the acoustic assembly by the generator 20. Asnoted above, the triggering mechanism of the generator 20 allows a userto activate the generator 20 so that electrical energy may becontinuously supplied to the acoustic assembly. The generator 20 alsohas a power line for insertion in an electro-surgical unit orconventional electrical outlet. It is contemplated that the generator 20can also be powered by a direct current (DC) source, such as a battery.The generator 20 can comprise any suitable generator, such as Model No.GEN04, and/or Model No. GEN11 available from Ethicon Endo-Surgery, Inc.

FIG. 2 is a left perspective view of one example embodiment of theultrasonic surgical instrument 10 showing the handle assembly 12, thedistal rotation assembly 13, the elongated shaft assembly 14, and theend effector assembly 26. In the illustrated embodiment the elongatedshaft assembly 14 comprises a distal end 52 dimensioned to mechanicallyengage the end effector assembly 26 and a proximal end 50 thatmechanically engages the handle assembly 12 and the distal rotationassembly 13. The proximal end 50 of the elongated shaft assembly 14 isreceived within the handle assembly 12 and the distal rotation assembly13. More details relating to the connections between the elongated shaftassembly 14, the handle assembly 12, and the distal rotation assembly 13are provided in the description of FIGS. 5 and 7.

In the illustrated embodiment, the trigger assembly 24 comprises atrigger 32 that operates in conjunction with a fixed handle 34. Thefixed handle 34 and the trigger 32 are ergonomically formed and adaptedto interface comfortably with the user. The fixed handle 34 isintegrally associated with the handle assembly 12. The trigger 32 ispivotally movable relative to the fixed handle 34 as explained in moredetail below with respect to the operation of the ultrasonic surgicalinstrument 10. The trigger 32 is pivotally movable in direction 33Atoward the fixed handle 34 when the user applies a squeezing forceagainst the trigger 32. A spring element 98 (FIG. 5) causes the trigger32 to pivotally move in direction 33B when the user releases thesqueezing force against the trigger 32.

In one example embodiment, the trigger 32 comprises an elongated triggerhook 36, which defines an aperture 38 between the elongated trigger hook36 and the trigger 32. The aperture 38 is suitably sized to receive oneor multiple fingers of the user therethrough. The trigger 32 also maycomprise a resilient portion 32 a molded over the trigger 32 substrate.The resilient portion 32 a is formed to provide a more comfortablecontact surface for control of the trigger 32 in outward direction 33B.In one example embodiment, the resilient portion 32 a may also beprovided over a portion of the elongated trigger hook 36 as shown, forexample, in FIG. 2. The proximal surface of the elongated trigger hook32 remains uncoated or coated with a non-resilient substrate to enablethe user to easily slide their fingers in and out of the aperture 38. Inanother embodiment, the geometry of the trigger forms a fully closedloop which defines an aperture suitably sized to receive one or multiplefingers of the user therethrough. The fully closed loop trigger also maycomprise a resilient portion molded over the trigger substrate.

In one example embodiment, the fixed handle 34 comprises a proximalcontact surface 40 and a grip anchor or saddle surface 42. The saddlesurface 42 rests on the web where the thumb and the index finger arejoined on the hand. The proximal contact surface 40 has a pistol gripcontour that receives the palm of the hand in a normal pistol grip withno rings or apertures. The profile curve of the proximal contact surface40 may be contoured to accommodate or receive the palm of the hand. Astabilization tail 44 is located towards a more proximal portion of thehandle assembly 12. The stabilization tail 44 may be in contact with theuppermost web portion of the hand located between the thumb and theindex finger to stabilize the handle assembly 12 and make the handleassembly 12 more controllable.

In one example embodiment, the switch assembly 28 may comprise a toggleswitch 30. The toggle switch 30 may be implemented as a single componentwith a central pivot 304 located within inside the handle assembly 12 toeliminate the possibility of simultaneous activation. In one exampleembodiment, the toggle switch 30 comprises a first projecting knob 30 aand a second projecting knob 30 b to set the power setting of theultrasonic transducer 16 between a minimum power level (e.g., MIN) and amaximum power level (e.g., MAX). In another embodiment, the rockerswitch may pivot between a standard setting and a special setting. Thespecial setting may allow one or more special programs to be implementedby the device. The toggle switch 30 rotates about the central pivot asthe first projecting knob 30 a and the second projecting knob 30 b areactuated. The one or more projecting knobs 30 a, 30 b are coupled to oneor more arms that move through a small arc and cause electrical contactsto close or open an electric circuit to electrically energize orde-energize the ultrasonic transducer 16 in accordance with theactivation of the first or second projecting knobs 30 a, 30 b. Thetoggle switch 30 is coupled to the generator 20 to control theactivation of the ultrasonic transducer 16. The toggle switch 30comprises one or more electrical power setting switches to activate theultrasonic transducer 16 to set one or more power settings for theultrasonic transducer 16. The forces required to activate the toggleswitch 30 are directed substantially toward the saddle point 42, thusavoiding any tendency of the instrument to rotate in the hand when thetoggle switch 30 is activated.

In one example embodiment, the first and second projecting knobs 30 a,30 b are located on the distal end of the handle assembly 12 such thatthey can be easily accessible by the user to activate the power withminimal, or substantially no, repositioning of the hand grip, making itsuitable to maintain control and keep attention focused on the surgicalsite (e.g., a monitor in a laparoscopic procedure) while activating thetoggle switch 30. The projecting knobs 30 a, 30 b may be configured towrap around the side of the handle assembly 12 to some extent to be moreeasily accessible by variable finger lengths and to allow greaterfreedom of access to activation in awkward positions or for shorterfingers.

In the illustrated embodiment, the first projecting knob 30 a comprisesa plurality of tactile elements 30 c, e.g., textured projections or“bumps” in the illustrated embodiment, to allow the user todifferentiate the first projecting knob 30 a from the second projectingknob 30 b. It will be appreciated by those skilled in the art thatseveral ergonomic features may be incorporated into the handle assembly12. Such ergonomic features are described in U.S. Pat. App. Pub. No.2009/0105750 entitled “Ergonomic Surgical Instruments”, now U.S. Pat.No. 8,623,027, which is incorporated by reference herein in itsentirety.

In one example embodiment, the toggle switch 30 may be operated by thehand of the user. The user may easily access the first and secondprojecting knobs 30 a, 30 b at any point while also avoiding inadvertentor unintentional activation at any time. The toggle switch 30 mayreadily operated with a finger to control the power to the ultrasonicassembly 16 and/or to the ultrasonic assembly 16. For example, the indexfinger may be employed to activate the first contact portion 30 a toturn on the ultrasonic assembly 16 to a maximum (MAX) power level. Theindex finger may be employed to activate the second contact portion 30 bto turn on the ultrasonic assembly 16 to a minimum (MIN) power level. Inanother embodiment, the rocker switch may pivot the instrument 10between a standard setting and a special setting. The special settingmay allow one or more special programs to be implemented by theinstrument 10. The toggle switch 30 may be operated without the userhaving to look at the first or second projecting knob 30 a, 30 b. Forexample, the first projecting knob 30 a or the second projecting knob 30b may comprise a texture or projections to tactilely differentiatebetween the first and second projecting knobs 30 a, 30 b withoutlooking.

In other embodiments, the trigger 32 and/or the toggle switch 30 may beemployed to actuate the electrosurgical/RF generator module 23individually or in combination with activation of the ultrasonicgenerator module 21.

In one example embodiment, the distal rotation assembly 13 is rotatablewithout limitation in either direction about a longitudinal axis “T.”The distal rotation assembly 13 is mechanically engaged to the elongatedshaft assembly 14. The distal rotation assembly 13 is located on adistal end of the handle assembly 12. The distal rotation assembly 13comprises a cylindrical hub 46 and a rotation knob 48 formed over thehub 46. The hub 46 mechanically engages the elongated shaft assembly 14.The rotation knob 48 may comprise fluted polymeric features and may beengaged by a finger (e.g., an index finger) to rotate the elongatedshaft assembly 14. The hub 46 may comprise a material molded over theprimary structure to form the rotation knob 48. The rotation knob 48 maybe overmolded over the hub 46. The hub 46 comprises an end cap portion46 a that is exposed at the distal end. The end cap portion 46 a of thehub 46 may contact the surface of a trocar during laparoscopicprocedures. The hub 46 may be formed of a hard durable plastic such aspolycarbonate to alleviate any friction that may occur between the endcap portion 46 a and the trocar. The rotation knob 48 may comprise“scallops” or flutes formed of raised ribs 48 a and concave portions 48b located between the ribs 48 a to provide a more precise rotationalgrip. In one example embodiment, the rotation knob 48 may comprise aplurality of flutes (e.g., three or more flutes). In other embodiments,any suitable number of flutes may be employed. The rotation knob 48 maybe formed of a softer polymeric material overmolded onto the hardplastic material. For example, the rotation knob 48 may be formed ofpliable, resilient, flexible polymeric materials including Versaflex®TPE alloys made by GLS Corporation, for example. This softer overmoldedmaterial may provide a greater grip and more precise control of themovement of the rotation knob 48. It will be appreciated that anymaterials that provide adequate resistance to sterilization, arebiocompatible, and provide adequate frictional resistance to surgicalgloves may be employed to form the rotation knob 48.

In one example embodiment, the handle assembly 12 is formed from two (2)housing portions or shrouds comprising a first portion 12 a and a secondportion 12 b. From the perspective of a user viewing the handle assembly12 from the distal end towards the proximal end, the first portion 12 ais considered the right portion and the second portion 12 b isconsidered the left portion. Each of the first and second portions 12 a,12 b includes a plurality of interfaces 69 (FIG. 7) dimensioned tomechanically align and engage each another to form the handle assembly12 and enclosing the internal working components thereof. The fixedhandle 34, which is integrally associated with the handle assembly 12,takes shape upon the assembly of the first and second portions 12 a and12 b of the handle assembly 12. A plurality of additional interfaces(not shown) may be disposed at various points around the periphery ofthe first and second portions 12 a and 12 b of the handle assembly 12for ultrasonic welding purposes, e.g., energy direction/deflectionpoints. The first and second portions 12 a and 12 b (as well as theother components described below) may be assembled together in anyfashion known in the art. For example, alignment pins, snap-likeinterfaces, tongue and groove interfaces, locking tabs, adhesive ports,may all be utilized either alone or in combination for assemblypurposes.

In one example embodiment, the elongated shaft assembly 14 comprises aproximal end 50 adapted to mechanically engage the handle assembly 12and the distal rotation assembly 13; and a distal end 52 adapted tomechanically engage the end effector assembly 26. The elongated shaftassembly 14 comprises an outer tubular sheath 56 and a reciprocatingtubular actuating member 58 located within the outer tubular sheath 56.The proximal end of the tubular reciprocating tubular actuating member58 is mechanically engaged to the trigger 32 of the handle assembly 12to move in either direction 60A or 60B in response to the actuationand/or release of the trigger 32. The pivotably moveable trigger 32 maygenerate reciprocating motion along the longitudinal axis “T.” Suchmotion may be used, for example, to actuate the jaws or clampingmechanism of the end effector assembly 26. A series of linkagestranslate the pivotal rotation of the trigger 32 to axial movement of ayoke coupled to an actuation mechanism, which controls the opening andclosing of the jaws of the clamping mechanism of the end effectorassembly 26. The distal end of the tubular reciprocating tubularactuating member 58 is mechanically engaged to the end effector assembly26. In the illustrated embodiment, the distal end of the tubularreciprocating tubular actuating member 58 is mechanically engaged to aclamp arm assembly 64, which is pivotable about a pivot point 70, toopen and close the clamp arm assembly 64 in response to the actuationand/or release of the trigger 32. For example, in the illustratedembodiment, the clamp arm assembly 64 is movable in direction 62A froman open position to a closed position about a pivot point 70 when thetrigger 32 is squeezed in direction 33A. The clamp arm assembly 64 ismovable in direction 62B from a closed position to an open positionabout the pivot point 70 when the trigger 32 is released or outwardlycontacted in direction 33B.

In one example embodiment, the end effector assembly 26 is attached atthe distal end 52 of the elongated shaft assembly 14 and includes aclamp arm assembly 64 and a blade 66. The jaws of the clamping mechanismof the end effector assembly 26 are formed by clamp arm assembly 64 andthe blade 66. The blade 66 is ultrasonically actuatable and isacoustically coupled to the ultrasonic transducer 16. The trigger 32 onthe handle assembly 12 is ultimately connected to a drive assembly,which together, mechanically cooperate to effect movement of the clamparm assembly 64. Squeezing the trigger 32 in direction 33A moves theclamp arm assembly 64 in direction 62A from an open position, whereinthe clamp arm assembly 64 and the blade 66 are disposed in a spacedrelation relative to one another, to a clamped or closed position,wherein the clamp arm assembly 64 and the blade 66 cooperate to grasptissue therebetween. The clamp arm assembly 64 may comprise a clamp pad(not shown) to engage tissue between the blade 66 and the clamp arm 64.Releasing the trigger 32 in direction 33B moves the clamp arm assembly64 in direction 62B from a closed relationship, to an open position,wherein the clamp arm assembly 64 and the blade 66 are disposed in aspaced relation relative to one another.

The proximal portion of the handle assembly 12 comprises a proximalopening 68 to receive the distal end of the ultrasonic assembly 16. Theultrasonic assembly 16 is inserted in the proximal opening 68 and ismechanically engaged to the elongated shaft assembly 14.

In one example embodiment, the elongated trigger hook 36 portion of thetrigger 32 provides a longer trigger lever with a shorter span androtation travel. The longer lever of the elongated trigger hook 36allows the user to employ multiple fingers within the aperture 38 tooperate the elongated trigger hook 36 and cause the trigger 32 to pivotin direction 33B to open the jaws of the end effector assembly 26. Forexample, the user may insert three fingers (e.g., the middle, ring, andlittle fingers) in the aperture 38. Multiple fingers allows the surgeonto exert higher input forces on the trigger 32 and the elongated triggerhook 36 to activate the end effector assembly 26. The shorter span androtation travel creates a more comfortable grip when closing orsqueezing the trigger 32 in direction 33A or when opening the trigger 32in the outward opening motion in direction 33B lessening the need toextend the fingers further outward. This substantially lessens handfatigue and strain associated with the outward opening motion of thetrigger 32 in direction 33B. The outward opening motion of the triggermay be spring-assisted by spring element 98 (FIG. 5) to help alleviatefatigue. The opening spring force is sufficient to assist the ease ofopening, but not strong enough to adversely impact the tactile feedbackof tissue tension during spreading dissection.

For example, during a surgical procedure the index finger may be used tocontrol the rotation of the elongated shaft assembly 14 to locate thejaws of the end effector assembly 26 in a suitable orientation. Themiddle and/or the other lower fingers may be used to squeeze the trigger32 and grasp tissue within the jaws. Once the jaws are located in thedesired position and the jaws are clamped against the tissue, the indexfinger can be used to activate the toggle switch 30 to adjust the powerlevel of the ultrasonic transducer 16 to treat the tissue. Once thetissue has been treated, the user may release the trigger 32 by pushingoutwardly in the distal direction against the elongated trigger hook 36with the middle and/or lower fingers to open the jaws of the endeffector assembly 26. This basic procedure may be performed without theuser having to adjust their grip of the handle assembly 12.

FIGS. 3-4 illustrate the connection of the elongated shaft assembly 14relative to the end effector assembly 26. As previously described, inthe illustrated embodiment, the end effector assembly 26 comprises aclamp arm assembly 64 and a blade 66 to form the jaws of the clampingmechanism. The blade 66 may be an ultrasonically actuatable bladeacoustically coupled to the ultrasonic transducer 16. The trigger 32 ismechanically connected to a drive assembly. Together, the trigger 32 andthe drive assembly mechanically cooperate to move the clamp arm assembly64 to an open position in direction 62A wherein the clamp arm assembly64 and the blade 66 are disposed in spaced relation relative to oneanother, to a clamped or closed position in direction 62B wherein theclamp arm assembly 64 and the blade 66 cooperate to grasp tissuetherebetween. The clamp arm assembly 64 may comprise a clamp pad (notshown) to engage tissue between the blade 66 and the clamp arm 64. Thedistal end of the tubular reciprocating tubular actuating member 58 ismechanically engaged to the end effector assembly 26. In the illustratedembodiment, the distal end of the tubular reciprocating tubularactuating member 58 is mechanically engaged to the clamp arm assembly64, which is pivotable about the pivot point 70, to open and close theclamp arm assembly 64 in response to the actuation and/or release of thetrigger 32. For example, in the illustrated embodiment, the clamp armassembly 64 is movable from an open position to a closed position indirection 62B about a pivot point 70 when the trigger 32 is squeezed indirection 33A. The clamp arm assembly 64 is movable from a closedposition to an open position in direction 62A about the pivot point 70when the trigger 32 is released or outwardly contacted in direction 33B.

As previously discussed, the clamp arm assembly 64 may compriseelectrodes electrically coupled to the electrosurgical/RF generatormodule 23 to receive therapeutic and/or sub-therapeutic energy, wherethe electrosurgical/RF energy may be applied to the electrodes eithersimultaneously or non-simultaneously with the ultrasonic energy beingapplied to the blade 66. Such energy activations may be applied in anysuitable combinations to achieve a desired tissue effect in cooperationwith an algorithm or other control logic.

FIG. 5 is an exploded view of the ultrasonic surgical instrument 10shown in FIG. 2. In the illustrated embodiment, the exploded view showsthe internal elements of the handle assembly 12, the handle assembly 12,the distal rotation assembly 13, the switch assembly 28, and theelongated shaft assembly 14. In the illustrated embodiment, the firstand second portions 12 a, 12 b mate to form the handle assembly 12. Thefirst and second portions 12 a, 12 b each comprises a plurality ofinterfaces 69 dimensioned to mechanically align and engage one anotherto form the handle assembly 12 and enclose the internal workingcomponents of the ultrasonic surgical instrument 10. The rotation knob48 is mechanically engaged to the outer tubular sheath 56 so that it maybe rotated in circular direction 54 up to 360°. The outer tubular sheath56 is located over the reciprocating tubular actuating member 58, whichis mechanically engaged to and retained within the handle assembly 12via a plurality of coupling elements 72. The coupling elements 72 maycomprise an O-ring 72 a, a tube collar cap 72 b, a distal washer 72 c, aproximal washer 72 d, and a thread tube collar 72 e. The reciprocatingtubular actuating member 58 is located within a reciprocating yoke 84,which is retained between the first and second portions 12 a, 12 b ofthe handle assembly 12. The yoke 84 is part of a reciprocating yokeassembly 88. A series of linkages translate the pivotal rotation of theelongated trigger hook 32 to the axial movement of the reciprocatingyoke 84, which controls the opening and closing of the jaws of theclamping mechanism of the end effector assembly 26 at the distal end ofthe ultrasonic surgical instrument 10. In one example embodiment, afour-link design provides mechanical advantage in a relatively shortrotation span, for example.

In one example embodiment, an ultrasonic transmission waveguide 78 isdisposed inside the reciprocating tubular actuating member 58. Thedistal end 52 of the ultrasonic transmission waveguide 78 isacoustically coupled (e.g., directly or indirectly mechanically coupled)to the blade 66 and the proximal end 50 of the ultrasonic transmissionwaveguide 78 is received within the handle assembly 12. The proximal end50 of the ultrasonic transmission waveguide 78 is adapted toacoustically couple to the distal end of the ultrasonic transducer 16 asdiscussed in more detail below. The ultrasonic transmission waveguide 78is isolated from the other elements of the elongated shaft assembly 14by a protective sheath 80 and a plurality of isolation elements 82, suchas silicone rings. The outer tubular sheath 56, the reciprocatingtubular actuating member 58, and the ultrasonic transmission waveguide78 are mechanically engaged by a pin 74. The switch assembly 28comprises the toggle switch 30 and electrical elements 86 a,b toelectrically energize the ultrasonic transducer 16 in accordance withthe activation of the first or second projecting knobs 30 a, 30 b.

In one example embodiment, the outer tubular sheath 56 isolates the useror the patient from the ultrasonic vibrations of the ultrasonictransmission waveguide 78. The outer tubular sheath 56 generallyincludes a hub 76. The outer tubular sheath 56 is threaded onto thedistal end of the handle assembly 12. The ultrasonic transmissionwaveguide 78 extends through the opening of the outer tubular sheath 56and the isolation elements 82 isolate the ultrasonic transmissionwaveguide 78 from the outer tubular sheath 56. The outer tubular sheath56 may be attached to the waveguide 78 with the pin 74. The hole toreceive the pin 74 in the waveguide 78 may occur nominally at adisplacement node. The waveguide 78 may screw or snap into the handpiece handle assembly 12 by a stud. Flat portions on the hub 76 mayallow the assembly to be torqued to a required level. In one exampleembodiment, the hub 76 portion of the outer tubular sheath 56 ispreferably constructed from plastic and the tubular elongated portion ofthe outer tubular sheath 56 is fabricated from stainless steel.Alternatively, the ultrasonic transmission waveguide 78 may comprisepolymeric material surrounding it to isolate it from outside contact.

In one example embodiment, the distal end of the ultrasonic transmissionwaveguide 78 may be coupled to the proximal end of the blade 66 by aninternal threaded connection, preferably at or near an antinode. It iscontemplated that the blade 66 may be attached to the ultrasonictransmission waveguide 78 by any suitable means, such as a welded jointor the like. Although the blade 66 may be detachable from the ultrasonictransmission waveguide 78, it is also contemplated that the singleelement end effector (e.g., the blade 66) and the ultrasonictransmission waveguide 78 may be formed as a single unitary piece.

In one example embodiment, the trigger 32 is coupled to a linkagemechanism to translate the rotational motion of the trigger 32 indirections 33A and 33B to the linear motion of the reciprocating tubularactuating member 58 in corresponding directions 60A and 60B. The trigger32 comprises a first set of flanges 97 with openings formed therein toreceive a first yoke pin 94 a. The first yoke pin 94 a is also locatedthrough a set of openings formed at the distal end of the yoke 84. Thetrigger 32 also comprises a second set of flanges 96 to receive a firstend 92 a of a link 92. A trigger pin 90 is received in openings formedin the link 92 and the second set of flanges 96. The trigger pin 90 isreceived in the openings formed in the link 92 and the second set offlanges 96 and is adapted to couple to the first and second portions 12a, 12 b of the handle assembly 12 to form a trigger pivot point for thetrigger 32. A second end 92 b of the link 92 is received in a slot 93formed in a proximal end of the yoke 84 and is retained therein by asecond yoke pin 94 b. As the trigger 32 is pivotally rotated about thepivot point 190 formed by the trigger pin 90, the yoke translateshorizontally along longitudinal axis “T” in a direction indicated byarrows 60A,B.

FIG. 8 illustrates one example embodiment of an ultrasonic surgicalinstrument 10. In the illustrated embodiment, a cross-sectional view ofthe ultrasonic transducer 16 is shown within a partial cutaway view ofthe handle assembly 12. One example embodiment of the ultrasonicsurgical instrument 10 comprises the ultrasonic signal generator 20coupled to the ultrasonic transducer 16, comprising a hand piece housing99, and an ultrasonically actuatable single or multiple element endeffector assembly 26. As previously discussed, the end effector assembly26 comprises the ultrasonically actuatable blade 66 and the clamp arm64. The ultrasonic transducer 16, which is known as a “Langevin stack”,generally includes a transduction portion 100, a first resonator portionor end-bell 102, and a second resonator portion or fore-bell 104, andancillary components. The total construction of these components is aresonator. The ultrasonic transducer 16 is preferably an integral numberof one-half system wavelengths (nλ/2; where “n” is any positive integer;e.g., n=1, 2, 3 . . . ) in length as will be described in more detaillater. An acoustic assembly 106 includes the ultrasonic transducer 16, anose cone 108, a velocity transformer 118, and a surface 110.

In one example embodiment, the distal end of the end-bell 102 isconnected to the proximal end of the transduction portion 100, and theproximal end of the fore-bell 104 is connected to the distal end of thetransduction portion 100. The fore-bell 104 and the end-bell 102 have alength determined by a number of variables, including the thickness ofthe transduction portion 100, the density and modulus of elasticity ofthe material used to manufacture the end-bell 102 and the fore-bell 22,and the resonant frequency of the ultrasonic transducer 16. Thefore-bell 104 may be tapered inwardly from its proximal end to itsdistal end to amplify the ultrasonic vibration amplitude as the velocitytransformer 118, or alternately may have no amplification. A suitablevibrational frequency range may be about 20 Hz to 32 kHz and awell-suited vibrational frequency range may be about 30-10 kHz. Asuitable operational vibrational frequency may be approximately 55.5kHz, for example.

In one example embodiment, the piezoelectric elements 112 may befabricated from any suitable material, such as, for example, leadzirconate-titanate, lead meta-niobate, lead titanate, barium titanate,or other piezoelectric ceramic material. Each of positive electrodes114, negative electrodes 116, and the piezoelectric elements 112 has abore extending through the center. The positive and negative electrodes114 and 116 are electrically coupled to wires 120 and 122, respectively.The wires 120 and 122 are encased within the cable 22 and electricallyconnectable to the ultrasonic signal generator 20.

The ultrasonic transducer 16 of the acoustic assembly 106 converts theelectrical signal from the ultrasonic signal generator 20 intomechanical energy that results in primarily a standing acoustic wave oflongitudinal vibratory motion of the ultrasonic transducer 16 and theblade 66 portion of the end effector assembly 26 at ultrasonicfrequencies. In another embodiment, the vibratory motion of theultrasonic transducer may act in a different direction. For example, thevibratory motion may comprise a local longitudinal component of a morecomplicated motion of the tip of the elongated shaft assembly 14. Asuitable generator is available as model number GEN11, from EthiconEndo-Surgery, Inc., Cincinnati, Ohio. When the acoustic assembly 106 isenergized, a vibratory motion standing wave is generated through theacoustic assembly 106. The ultrasonic surgical instrument 10 is designedto operate at a resonance such that an acoustic standing wave pattern ofpredetermined amplitude is produced. The amplitude of the vibratorymotion at any point along the acoustic assembly 106 depends upon thelocation along the acoustic assembly 106 at which the vibratory motionis measured. A minimum or zero crossing in the vibratory motion standingwave is generally referred to as a node (i.e., where motion is minimal),and a local absolute value maximum or peak in the standing wave isgenerally referred to as an anti-node (e.g., where local motion ismaximal). The distance between an anti-node and its nearest node isone-quarter wavelength (λ/4).

The wires 120 and 122 transmit an electrical signal from the ultrasonicsignal generator 20 to the positive electrodes 114 and the negativeelectrodes 116. The piezoelectric elements 112 are energized by theelectrical signal supplied from the ultrasonic signal generator 20 inresponse to an actuator 224, such as a foot switch, for example, toproduce an acoustic standing wave in the acoustic assembly 106. Theelectrical signal causes disturbances in the piezoelectric elements 112in the form of repeated small displacements resulting in largealternating compression and tension forces within the material. Therepeated small displacements cause the piezoelectric elements 112 toexpand and contract in a continuous manner along the axis of the voltagegradient, producing longitudinal waves of ultrasonic energy. Theultrasonic energy is transmitted through the acoustic assembly 106 tothe blade 66 portion of the end effector assembly 26 via a transmissioncomponent or an ultrasonic transmission waveguide portion 78 of theelongated shaft assembly 14.

In one example embodiment, in order for the acoustic assembly 106 todeliver energy to the blade 66 portion of the end effector assembly 26,all components of the acoustic assembly 106 must be acoustically coupledto the blade 66. The distal end of the ultrasonic transducer 16 may beacoustically coupled at the surface 110 to the proximal end of theultrasonic transmission waveguide 78 by a threaded connection such as astud 124.

In one example embodiment, the components of the acoustic assembly 106are preferably acoustically tuned such that the length of any assemblyis an integral number of one-half wavelengths (nλ/2), where thewavelength λ is the wavelength of a pre-selected or operatinglongitudinal vibration drive frequency f_(d) of the acoustic assembly106. It is also contemplated that the acoustic assembly 106 mayincorporate any suitable arrangement of acoustic elements.

In one example embodiment, the blade 66 may have a length substantiallyequal to an integral multiple of one-half system wavelengths (nλ/2). Adistal end of the blade 66 may be disposed near an antinode in order toprovide the maximum longitudinal excursion of the distal end. When thetransducer assembly is energized, the distal end of the blade 66 may beconfigured to move in the range of, for example, approximately 10 to 500microns peak-to-peak, and preferably in the range of about 30 to 64microns at a predetermined vibrational frequency of 55 kHz, for example.

In one example embodiment, the blade 66 may be coupled to the ultrasonictransmission waveguide 78. The blade 66 and the ultrasonic transmissionwaveguide 78 as illustrated are formed as a single unit constructionfrom a material suitable for transmission of ultrasonic energy. Examplesof such materials include Ti6Al4V (an alloy of Titanium includingAluminum and Vanadium), Aluminum, Stainless Steel, or other suitablematerials. Alternately, the blade 66 may be separable (and of differingcomposition) from the ultrasonic transmission waveguide 78, and coupledby, for example, a stud, weld, glue, quick connect, or other suitableknown methods. The length of the ultrasonic transmission waveguide 78may be substantially equal to an integral number of one-half wavelengths(nλ/2), for example. The ultrasonic transmission waveguide 78 may bepreferably fabricated from a solid core shaft constructed out ofmaterial suitable to propagate ultrasonic energy efficiently, such asthe titanium alloy discussed above (i.e., Ti6Al4V) or any suitablealuminum alloy, or other alloys, for example.

In one example embodiment, the ultrasonic transmission waveguide 78comprises a longitudinally projecting attachment post at a proximal endto couple to the surface 110 of the ultrasonic transmission waveguide 78by a threaded connection such as the stud 124. The ultrasonictransmission waveguide 78 may include a plurality of stabilizingsilicone rings or compliant supports 82 (FIG. 5) positioned at aplurality of nodes. The silicone rings 82 dampen undesirable vibrationand isolate the ultrasonic energy from an outer protective sheath 80(FIG. 5) assuring the flow of ultrasonic energy in a longitudinaldirection to the distal end of the blade 66 with maximum efficiency.

FIG. 9 illustrates one example embodiment of the proximal rotationassembly 128. In the illustrated embodiment, the proximal rotationassembly 128 comprises the proximal rotation knob 134 inserted over thecylindrical hub 135. The proximal rotation knob 134 comprises aplurality of radial projections 138 that are received in correspondingslots 130 formed on a proximal end of the cylindrical hub 135. Theproximal rotation knob 134 defines an opening 142 to receive the distalend of the ultrasonic transducer 16. The radial projections 138 areformed of a soft polymeric material and define a diameter that isundersized relative to the outside diameter of the ultrasonic transducer16 to create a friction interference fit when the distal end of theultrasonic transducer 16. The polymeric radial projections 138 protruderadially into the opening 142 to form “gripper” ribs that firmly gripthe exterior housing of the ultrasonic transducer 16. Therefore, theproximal rotation knob 134 securely grips the ultrasonic transducer 16.

The distal end of the cylindrical hub 135 comprises a circumferentiallip 132 and a circumferential bearing surface 140. The circumferentiallip engages a groove formed in the housing 12 and the circumferentialbearing surface 140 engages the housing 12. Thus, the cylindrical hub135 is mechanically retained within the two housing portions (not shown)of the housing 12. The circumferential lip 132 of the cylindrical hub135 is located or “trapped” between the first and second housingportions 12 a, 12 b and is free to rotate in place within the groove.The circumferential bearing surface 140 bears against interior portionsof the housing to assist proper rotation. Thus, the cylindrical hub 135is free to rotate in place within the housing. The user engages theflutes 136 formed on the proximal rotation knob 134 with either thefinger or the thumb to rotate the cylindrical hub 135 within the housing12.

In one example embodiment, the cylindrical hub 135 may be formed of adurable plastic such as polycarbonate. In one example embodiment, thecylindrical hub 135 may be formed of a siliconized polycarbonatematerial. In one example embodiment, the proximal rotation knob 134 maybe formed of pliable, resilient, flexible polymeric materials includingVersaflex® TPE alloys made by GLS Corporation, for example. The proximalrotation knob 134 may be formed of elastomeric materials, thermoplasticrubber known as Santoprene®, other thermoplastic vulcanizates (TPVs), orelastomers, for example. The embodiments, however, are not limited inthis context.

FIG. 10 illustrates one example embodiment of a surgical system 200including a surgical instrument 210 having single element end effector278. The system 200 may include a transducer assembly 216 coupled to theend effector 278 and a sheath 256 positioned around the proximalportions of the end effector 278 as shown. The transducer assembly 216and end effector 278 may operate in a manner similar to that of thetransducer assembly 16 and end effector 18 described above to produceultrasonic energy that may be transmitted to tissue via blade 226.

FIGS. 11-18C illustrate various embodiments of surgical instruments thatutilize therapeutic and/or sub-therapeutic electrical energy to treatand/or destroy tissue or provide feedback to the generators (e.g.,electrosurgical instruments). The embodiments of FIGS. 11-18C areadapted for use in a manual or hand-operated manner, althoughelectrosurgical instruments may be utilized in robotic applications aswell. FIG. 11 is a perspective view of one example embodiment of asurgical instrument system 300 comprising an electrical energy surgicalinstrument 310. The electrosurgical instrument 310 may comprise aproximal handle 312, a distal working end or end effector 326 and anintroducer or elongated shaft 314 disposed in-between.

The electrosurgical system 300 can be configured to supply energy, suchas electrical energy, ultrasonic energy, heat energy, or any combinationthereof, to the tissue of a patient either independently orsimultaneously as described, for example, in connection with FIG. 1, forexample. In one example embodiment, the electrosurgical system 300includes a generator 320 in electrical communication with theelectrosurgical instrument 310. The generator 320 is connected toelectrosurgical instrument 310 via a suitable transmission medium suchas a cable 322. In one example embodiment, the generator 320 is coupledto a controller, such as a control unit 325, for example. In variousembodiments, the control unit 325 may be formed integrally with thegenerator 320 or may be provided as a separate circuit module or deviceelectrically coupled to the generator 320 (shown in phantom as 325′ toillustrate this option). Although in the presently disclosed embodiment,the generator 320 is shown separate from the electrosurgical instrument310, in one example embodiment, the generator 320 (and/or the controlunit 325) may be formed integrally with the electrosurgical instrument310 to form a unitary electrosurgical system 300, where a batterylocated within the electrosurgical instrument 310 is the energy sourceand a circuit coupled to the battery produces the suitable electricalenergy, ultrasonic energy, or heat energy. One such example is describedherein below in connection with FIGS. 17-18C.

The generator 320 may comprise an input device 335 located on a frontpanel of the generator 320 console. The input device 335 may compriseany suitable device that generates signals suitable for programming theoperation of the generator 320, such as a keyboard, or input port, forexample. In one example embodiment, various electrodes in the first jaw364A and the second jaw 364B may be coupled to the generator 320. Thecable 322 may comprise multiple electrical conductors for theapplication of electrical energy to positive (+) and negative (−)electrodes of the electrosurgical instrument 310. The control unit 325may be used to activate the generator 320, which may serve as anelectrical source. In various embodiments, the generator 320 maycomprise an RF source, an ultrasonic source, a direct current source,and/or any other suitable type of electrical energy source, for example,which may be activated independently or simultaneously.

In various embodiments, the electrosurgical system 300 may comprise atleast one supply conductor 331 and at least one return conductor 333,wherein current can be supplied to electrosurgical instrument 300 viathe supply conductor 331 and wherein the current can flow back to thegenerator 320 via the return conductor 333. In various embodiments, thesupply conductor 331 and the return conductor 333 may comprise insulatedwires and/or any other suitable type of conductor. In certainembodiments, as described below, the supply conductor 331 and the returnconductor 333 may be contained within and/or may comprise the cable 322extending between, or at least partially between, the generator 320 andthe end effector 326 of the electrosurgical instrument 310. In anyevent, the generator 320 can be configured to apply a sufficient voltagedifferential between the supply conductor 331 and the return conductor333 such that sufficient current can be supplied to the end effector110.

FIG. 12 is a side view of one example embodiment of the handle 312 ofthe surgical instrument 310. In FIG. 12, the handle 312 is shown withhalf of a first handle body 312A (see FIG. 11) removed to illustratevarious components within second handle body 312B. The handle 312 maycomprise a lever arm 321 (e.g., a trigger) which may be pulled along apath 33. The lever arm 321 may be coupled to an axially moveable member378 (FIGS. 13-16) disposed within elongated shaft 314 by a shuttle 384operably engaged to an extension 398 of lever arm 321. The shuttle 384may further be connected to a biasing device, such as a spring 388,which may also be connected to the second handle body 312B, to bias theshuttle 384 and thus the axially moveable member 378 in a proximaldirection, thereby urging the jaws 364A and 364B to an open position asseen in FIG. 11. Also, referring to FIGS. 11-12, a locking member 190(see FIG. 12) may be moved by a locking switch 328 (see FIG. 11) betweena locked position, where the shuttle 384 is substantially prevented frommoving distally as illustrated, and an unlocked position, where theshuttle 384 may be allowed to freely move in the distal direction,toward the elongated shaft 314. In some embodiments, the locking switch328 may be implemented as a button. The handle 312 can be any type ofpistol-grip or other type of handle known in the art that is configuredto carry actuator levers, triggers or sliders for actuating the firstjaw 364A and the second jaw 364B. The elongated shaft 314 may have acylindrical or rectangular cross-section, for example, and can comprisea thin-wall tubular sleeve that extends from handle 312. The elongatedshaft 314 may include a bore extending therethrough for carryingactuator mechanisms, for example, the axially moveable member 378, foractuating the jaws and for carrying electrical leads for delivery ofelectrical energy to electrosurgical components of the end effector 326.

The end effector 326 may be adapted for capturing and transecting tissueand for the contemporaneously welding the captured tissue withcontrolled application of energy (e.g., RF energy). The first jaw 364Aand the second jaw 364B may close to thereby capture or engage tissueabout a longitudinal axis “T” defined by the axially moveable member378. The first jaw 364A and second jaw 364B may also apply compressionto the tissue. In some embodiments, the elongated shaft 314, along withfirst jaw 364A and second jaw 364B, can be rotated a full 360° degrees,as shown by arrow 196 (see FIG. 11), relative to handle 312. Forexample, a rotation knob 348 may be rotatable about the longitudinalaxis of the shaft 314 and may be coupled to the shaft 314 such thatrotation of the knob 348 causes corresponding rotation of the shaft 314.The first jaw 364A and the second jaw 364B can remain openable and/orcloseable while rotated.

FIG. 13 shows a perspective view of one example embodiment of the endeffector 326 with the jaws 364A, 364B open, while FIG. 14 shows aperspective view of one example embodiment of the end effector 326 withthe jaws 364A, 364B closed. As noted above, the end effector 326 maycomprise the upper first jaw 364A and the lower second jaw 364B, whichmay be straight or curved. The first jaw 364A and the second jaw 364Bmay each comprise an elongated slot or channel 362A and 362B,respectively, disposed outwardly along their respective middle portions.Further, the first jaw 364A and second jaw 364B may each havetissue-gripping elements, such as teeth 363, disposed on the innerportions of first jaw 364A and second jaw 364B. The first jaw 364A maycomprise an upper first outward-facing surface 369A and an upper firstenergy delivery surface 365A. The second jaw 364B may comprise a lowersecond outward-facing surface 369B and a lower second energy deliverysurface 365B. The first energy delivery surface 365A and the secondenergy delivery surface 365B may both extend in a “U” shape about thedistal end of the end effector 326.

The lever arm 321 of the handle 312 (FIG. 12) may be adapted to actuatethe axially moveable member 378, which may also function as ajaw-closing mechanism. For example, the axially moveable member 378 maybe urged distally as the lever arm 321 is pulled proximally along thepath 33 via the shuttle 384, as shown in FIG. 12 and discussed above.FIG. 15 is a perspective view of one example embodiment of the axiallymoveable member 378 of the surgical instrument 310. The axially moveablemember 378 may comprise one or several pieces, but in any event, may bemovable or translatable with respect to the elongated shaft 314 and/orthe jaws 364A, 364B. Also, in at least one example embodiment, theaxially moveable member 378 may be made of 17-4 precipitation hardenedstainless steel. The distal end of axially moveable member 378 maycomprise a flanged “I”-beam configured to slide within the channels 362Aand 362B in jaws 364A and 364B. The axially moveable member 378 mayslide within the channels 362A, 362B to open and close the first jaw364A and the second jaw 364B. The distal end of the axially moveablemember 378 may also comprise an upper flange or “c”-shaped portion 378Aand a lower flange or “c”-shaped portion 378B. The flanges 378A and 378Brespectively define inner cam surfaces 367A and 367B for engagingoutward facing surfaces of the first jaw 364A and the second jaw 364B.The opening-closing of jaws 364A and 364B can apply very highcompressive forces on tissue using cam mechanisms which may includemovable “I-beam” axially moveable member 378 and the outward facingsurfaces 369A, 369B of jaws 364A, 364B.

More specifically, referring now to FIGS. 13-15, collectively, the innercam surfaces 367A and 367B of the distal end of axially moveable member378 may be adapted to slidably engage the first outward-facing surface369A and the second outward-facing surface 369B of the first jaw 364Aand the second jaw 364B, respectively. The channel 362A within first jaw364A and the channel 362B within the second jaw 364B may be sized andconfigured to accommodate the movement of the axially moveable member378, which may comprise a tissue-cutting element 371, for example,comprising a sharp distal edge. FIG. 14, for example, shows the distalend of the axially moveable member 378 advanced at least partiallythrough channels 362A and 362B (FIG. 13). The advancement of the axiallymoveable member 378 may close the end effector 326 from the openconfiguration shown in FIG. 13. In the closed position shown by FIG. 14,the upper first jaw 364A and lower second jaw 364B define a gap ordimension D between the first energy delivery surface 365A and secondenergy delivery surface 365B of first jaw 364A and second jaw 364B,respectively. In various embodiments, dimension D can equal from about0.0005″ to about 0.040″, for example, and in some embodiments, betweenabout 0.001″ to about 0.010″, for example. Also, the edges of the firstenergy delivery surface 365A and the second energy delivery surface 365Bmay be rounded to prevent the dissection of tissue.

FIG. 16 is a section view of one example embodiment of the end effector326 of the surgical instrument 310. The engagement, ortissue-contacting, surface 365B of the lower jaw 364B is adapted todeliver energy to tissue, at least in part, through aconductive-resistive matrix, such as a variable resistive positivetemperature coefficient (PTC) body, as discussed in more detail below.At least one of the upper and lower jaws 364A, 364B may carry at leastone electrode 373 configured to deliver the energy from the generator320 to the captured tissue. The engagement, or tissue-contacting,surface 365A of upper jaw 364A may carry a similar conductive-resistivematrix (i.e., a PTC material), or in some embodiments the surface may bea conductive electrode or an insulative layer, for example.Alternatively, the engagement surfaces of the jaws can carry any of theenergy delivery components disclosed in U.S. Pat. No. 6,773,409, filedOct. 22, 2001, entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLEDENERGY DELIVERY, the entire disclosure of which is incorporated hereinby reference.

The first energy delivery surface 365A and the second energy deliverysurface 365B may each be in electrical communication with the generator320. The first energy delivery surface 365A and the second energydelivery surface 365B may be configured to contact tissue and deliverelectrosurgical energy to captured tissue which are adapted to seal orweld the tissue. The control unit 325 regulates the electrical energydelivered by electrical generator 320 which in turn deliverselectrosurgical energy to the first energy delivery surface 365A and thesecond energy delivery surface 365B. The energy delivery may beinitiated by an activation button 328 (FIG. 12) operably engaged withthe lever arm 321 and in electrical communication with the generator 320via cable 322. In one example embodiment, the electrosurgical instrument310 may be energized by the generator 320 by way of a foot switch 329(FIG. 11). When actuated, the foot switch 329 triggers the generator 320to deliver electrical energy to the end effector 326, for example. Thecontrol unit 325 may regulate the power generated by the generator 320during activation. Although the foot switch 329 may be suitable in manycircumstances, other suitable types of switches can be used.

As mentioned above, the electrosurgical energy delivered by electricalgenerator 320 and regulated, or otherwise controlled, by the controlunit 325 may comprise radio frequency (RF) energy, or other suitableforms of electrical energy. Further, the opposing first and secondenergy delivery surfaces 365A and 365B may carry variable resistivepositive temperature coefficient (PTC) bodies that are in electricalcommunication with the generator 320 and the control unit 325.Additional details regarding electrosurgical end effectors, jaw closingmechanisms, and electrosurgical energy-delivery surfaces are describedin the following U.S. patents and published patent applications: U.S.Pat. Nos. 7,087,054; 7,083,619; 7,070,597; 7,041,102; 7,011,657;6,929,644; 6,926,716; 6,913,579; 6,905,497; 6,802,843; 6,770,072;6,656,177; 6,533,784; and 6,500,312; and U.S. Pat. App. Pub. Nos.2010/0036370 and 2009/0076506, all of which are incorporated herein intheir entirety by reference and made a part of this specification.

In one example embodiment, the generator 320 may be implemented as anelectrosurgery unit (ESU) capable of supplying power sufficient toperform bipolar electrosurgery using radio frequency (RF) energy. In oneexample embodiment, the ESU can be a bipolar ERBE ICC 350 sold by ERBEUSA, Inc. of Marietta, Ga. In some embodiments, such as for bipolarelectrosurgery applications, a surgical instrument having an activeelectrode and a return electrode can be utilized, wherein the activeelectrode and the return electrode can be positioned against, adjacentto and/or in electrical communication with, the tissue to be treatedsuch that current can flow from the active electrode, through thepositive temperature coefficient (PTC) bodies and to the returnelectrode through the tissue. Thus, in various embodiments, theelectrosurgical system 300 may comprise a supply path and a return path,wherein the captured tissue being treated completes, or closes, thecircuit. In one example embodiment, the generator 320 may be a monopolarRF ESU and the electrosurgical instrument 310 may comprise a monopolarend effector 326 in which one or more active electrodes are integrated.For such a system, the generator 320 may require a return pad inintimate contact with the patient at a location remote from theoperative site and/or other suitable return path. The return pad may beconnected via a cable to the generator 320. In other embodiments, theoperator 20 may provide sub-therapeutic RF energy levels for purposes ofevaluating tissue conditions and providing feedback in theelectrosurgical system 300. Such feedback may be employed to control thetherapeutic RF energy output of the electrosurgical instrument 310.

During operation of electrosurgical instrument 300, the user generallygrasps tissue, supplies energy to the captured tissue to form a weld ora seal (e.g., by actuating button 328 and/or pedal 216), and then drivesa tissue-cutting element 371 at the distal end of the axially moveablemember 378 through the captured tissue. According to variousembodiments, the translation of the axial movement of the axiallymoveable member 378 may be paced, or otherwise controlled, to aid indriving the axially moveable member 378 at a suitable rate of travel. Bycontrolling the rate of the travel, the likelihood that the capturedtissue has been properly and functionally sealed prior to transectionwith the cutting element 371 is increased.

FIG. 17 is a perspective view of one example embodiment of a surgicalinstrument system comprising a cordless electrical energy surgicalinstrument 410. The electrosurgical system is similar to theelectrosurgical system 300. The electrosurgical system can be configuredto supply energy, such as electrical energy, ultrasonic energy, heatenergy, or any combination thereof, to the tissue of a patient eitherindependently or simultaneously as described in connection with FIGS. 1and 11, for example. The electrosurgical instrument may utilize the endeffector 326 and elongated shaft 314 described herein in conjunctionwith a cordless proximal handle 412. In one example embodiment, thehandle 412 includes a generator circuit 420 (see FIG. 18). The generatorcircuit 420 performs a function substantially similar to that ofgenerator 320. In one example embodiment, the generator circuit 420 iscoupled to a controller, such as a control circuit. In the illustratedembodiment, the control circuit is integrated into the generator circuit420. In other embodiments, the control circuit may be separate from thegenerator circuit 420.

In one example embodiment, various electrodes in the end effector 326(including jaws 364A, 364B thereof) may be coupled to the generatorcircuit 420. The control circuit may be used to activate the generator420, which may serve as an electrical source. In various embodiments,the generator 420 may comprise an RF source, an ultrasonic source, adirect current source, and/or any other suitable type of electricalenergy source, for example. In one example embodiment, a button 328 maybe provided to activate the generator circuit 420 to provide energy tothe end effectors 326, 326.

FIG. 18A is a side view of one example embodiment of the handle 412 ofthe cordless surgical instrument 410. In FIG. 18, the handle 412 isshown with half of a first handle body removed to illustrate variouscomponents within second handle body 434. The handle 412 may comprise alever arm 424 (e.g., a trigger) which may be pulled along a path 33around a pivot point. The lever arm 424 may be coupled to an axiallymoveable member 478 disposed within elongated shaft 314 by a shuttleoperably engaged to an extension of lever arm 424. In one exampleembodiment, the lever arm 424 defines a shepherd's hook shape comprisinga distal member 424 a and a proximal member 424 b.

In one example embodiment, the cordless electrosurgical instrumentcomprises a battery 437. The battery 437 provides electrical energy tothe generator circuit 420. The battery 437 may be any battery suitablefor driving the generator circuit 420 at the desired energy levels. Inone example embodiment, the battery 437 is a 100 mAh, triple-cellLithium Ion Polymer battery. The battery may be fully charged prior touse in a surgical procedure, and may hold a voltage of about 12.6V. Thebattery 437 may have two fuses fitted to the cordless electrosurgicalinstrument 410, arranged in line with each battery terminal. In oneexample embodiment, a charging port 439 is provided to connect thebattery 437 to a DC current source (not shown).

The generator circuit 420 may be configured in any suitable manner. Insome embodiments, the generator circuit comprises an RF drive andcontrol circuit 440. FIG. 18B illustrates an RF drive and controlcircuit 440, according to one embodiment. FIG. 18B is a part schematicpart block diagram illustrating the RF drive and control circuitry 440used in this embodiment to generate and control the RF electrical energysupplied to the end effector 326. As will be explained in more detailbelow, in this embodiment, the drive circuitry 440 is a resonant mode RFamplifier comprising a parallel resonant network on the RF amplifieroutput and the control circuitry operates to control the operatingfrequency of the drive signal so that it is maintained at the resonantfrequency of the drive circuit, which in turn controls the amount ofpower supplied to the end effector 326. The way that this is achievedwill become apparent from the following description.

As shown in FIG. 18B, the RF drive and control circuit 440 comprises theabove described battery 437 are arranged to supply, in this example,about 0V and about 12V rails. An input capacitor (C_(in)) 442 isconnected between the 0V and the 12V for providing a low sourceimpedance. A pair of FET switches 443-1 and 443-2 (both of which areN-channel in this embodiment to reduce power losses) is connected inseries between the 0V rail and the 12V rail. FET gate drive circuitry445 is provided that generates two drive signals—one for driving each ofthe two FETs 443. The FET gate drive circuitry 445 generates drivesignals that causes the upper FET (443-1) to be on when the lower FET(443-2) is off and vice versa. This causes the node 447 to bealternately connected to the 12V rail (when the FET 443-1 is switchedon) and the 0V rail (when the FET 443-2 is switched on). FIG. 18B alsoshows the internal parasitic diodes 448-1 and 448-2 of the correspondingFETs 443, which conduct during any periods that the FETs 443 are open.

As shown in FIG. 18B, the node 447 is connected to an inductor-inductorresonant circuit 450 formed by inductor L_(s) 452 and inductor L_(m)454. The FET gate driving circuitry 445 is arranged to generate drivesignals at a drive frequency (f_(d)) that opens and crosses the FETswitches 443 at the resonant frequency of the parallel resonant circuit450. As a result of the resonant characteristic of the resonant circuit450, the square wave voltage at node 447 will cause a substantiallysinusoidal current at the drive frequency (f_(d)) to flow within theresonant circuit 450. As illustrated in FIG. 18B, the inductor L_(m) 454is the primary of a transformer 455, the secondary of which is formed byinductor L_(sec) 456. The inductor L_(sec) 456 of the transformer 455secondary is connected to an inductor-capacitor-capacitor parallelresonant circuit 457 formed by inductor L₂ 458, capacitor C₄ 460, andcapacitor C₂ 462. The transformer 455 up-converts the drive voltage(V_(d)) across the inductor L_(m) 454 to the voltage that is applied tothe output parallel resonant circuit 457. The load voltage (V_(L)) isoutput by the parallel resonant circuit 457 and is applied to the load(represented by the load resistance R_(load) 459 in FIG. 18B)corresponding to the impedance of the forceps' jaws and any tissue orvessel gripped by the end effector 326. As shown in FIG. 18B, a pair ofDC blocking capacitors C_(bI) 480-1 and 480-2 is provided to prevent anyDC signal being applied to the load 459.

In one embodiment, the transformer 455 may be implemented with a CoreDiameter (mm), Wire Diameter (mm), and Gap between secondary windings inaccordance with the following specifications:

Core Diameter, D (mm)

D=19.9×10-3

Wire diameter, W (mm) for 22 AWG wire

W=7.366×10-4

Gap between secondary windings, in gap=0.125

G=gap/25.4

In this embodiment, the amount of electrical power supplied to the endeffector 326 is controlled by varying the frequency of the switchingsignals used to switch the FETs 443. This works because the resonantcircuit 450 acts as a frequency dependent (loss less) attenuator. Thecloser the drive signal is to the resonant frequency of the resonantcircuit 450, the less the drive signal is attenuated. Similarly, as thefrequency of the drive signal is moved away from the resonant frequencyof the circuit 450, the more the drive signal is attenuated and so thepower supplied to the load reduces. In this embodiment, the frequency ofthe switching signals generated by the FET gate drive circuitry 445 iscontrolled by a controller 481 based on a desired power to be deliveredto the load 459 and measurements of the load voltage (V_(L)) and of theload current (I_(L)) obtained by conventional voltage sensing circuitry483 and current sensing circuitry 485. The way that the controller 481operates will be described in more detail below.

In one embodiment, the voltage sensing circuitry 483 and the currentsensing circuitry 485 may be implemented with high bandwidth, high speedrail-to-rail amplifiers (e.g., LMH6643 by National Semiconductor). Suchamplifiers, however, consume a relatively high current when they areoperational. Accordingly, a power save circuit may be provided to reducethe supply voltage of the amplifiers when they are not being used in thevoltage sensing circuitry 483 and the current sensing circuitry 485. Inone-embodiment, a step-down regulator (e.g., LT3502 by LinearTechnologies) may be employed by the power save circuit to reduce thesupply voltage of the rail-to-rail amplifiers and thus extend the lifeof the battery 437.

FIG. 18C illustrates the main components of the controller 481,according to one embodiment. In the embodiment illustrated in FIG. 18C,the controller 481 is a microprocessor based controller and so most ofthe components illustrated in FIG. 16 are software based components.Nevertheless, a hardware based controller 481 may be used instead. Asshown, the controller 481 includes synchronous I,Q sampling circuitry491 that receives the sensed voltage and current signals from thesensing circuitry 483 and 485 and obtains corresponding samples whichare passed to a power, V_(rms) and I_(rms) calculation module 493. Thecalculation module 493 uses the received samples to calculate the RMSvoltage and RMS current applied to the load 459 (FIG. 18B; end effector326 and tissue/vessel gripped thereby) and from them the power that ispresently being supplied to the load 459. The determined values are thenpassed to a frequency control module 495 and a medical device controlmodule 497. The medical device control module 497 uses the values todetermine the present impedance of the load 459 and based on thisdetermined impedance and a pre-defined algorithm, determines what setpoint power (P_(set)) should be applied to the frequency control module495. The medical device control module 497 is in turn controlled bysignals received from a user input module 499 that receives inputs fromthe user (for example pressing buttons or activating the control levers114, 110 on the handle 104) and also controls output devices (lights, adisplay, speaker or the like) on the handle 104 via a user output module461.

The frequency control module 495 uses the values obtained from thecalculation module 493 and the power set point (P_(set)) obtained fromthe medical device control module 497 and predefined system limits (tobe explained below), to determine whether or not to increase or decreasethe applied frequency. The result of this decision is then passed to asquare wave generation module 463 which, in this embodiment, incrementsor decrements the frequency of a square wave signal that it generates by1 kHz, depending on the received decision. As those skilled in the artwill appreciate, in an alternative embodiment, the frequency controlmodule 495 may determine not only whether to increase or decrease thefrequency, but also the amount of frequency change required. In thiscase, the square wave generation module 463 would generate thecorresponding square wave signal with the desired frequency shift. Inthis embodiment, the square wave signal generated by the square wavegeneration module 463 is output to the FET gate drive circuitry 445,which amplifies the signal and then applies it to the FET 443-1. The FETgate drive circuitry 445 also inverts the signal applied to the FET443-1 and applies the inverted signal to the FET 443-2.

The electrosurgical instrument 410 may comprise additional features asdiscussed with respect to electrosurgical system 300. Those skilled inthe art will recognize that electrosurgical instrument 410 may include arotation knob 348, an elongated shaft 314, and an end effector 326.These elements function in a substantially similar manner to thatdiscussed above with respect to the electrosurgical system 300. In oneexample embodiment, the cordless electrosurgical instrument 410 mayinclude visual indicators 435. The visual indicators 435 may provide avisual indication signal to an operator. In one example embodiment, thevisual indication signal may alert an operator that the device is on, orthat the device is applying energy to the end effector. Those skilled inthe art will recognize that the visual indicators 435 may be configuredto provide information on multiple states of the device.

Over the years a variety of minimally invasive robotic (or“telesurgical”) systems have been developed to increase surgicaldexterity as well as to permit a surgeon to operate on a patient in anintuitive manner. Robotic surgical systems can be used with manydifferent types of surgical instruments including, for example,ultrasonic or electrosurgical instruments, as described herein. Examplerobotic systems include those manufactured by Intuitive Surgical, Inc.,of Sunnyvale, Calif., U.S.A. Such systems, as well as robotic systemsfrom other manufacturers, are disclosed in the following U.S. patentswhich are each herein incorporated by reference in their respectiveentirety: U.S. Pat. No. 5,792,135, entitled “Articulated SurgicalInstrument For Performing Minimally Invasive Surgery With EnhancedDexterity and Sensitivity”, U.S. Pat. No. 6,231,565, entitled “RoboticArm DLUs For Performing Surgical Tasks”, U.S. Pat. No. 6,783,524,entitled “Robotic Surgical Tool With Ultrasound Cauterizing and CuttingInstrument”, U.S. Pat. No. 6,364,888, entitled “Alignment of Master andSlave In a Minimally Invasive Surgical Apparatus”, U.S. Pat. No.7,524,320, entitled “Mechanical Actuator Interface System For RoboticSurgical Tools”, U.S. Pat. No. 7,691,098, entitled Platform Link WristMechanism”, U.S. Pat. No. 7,806,891, entitled “Repositioning andReorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery”, and U.S. Pat. No. 7,824,401, entitled “Surgical Tool WithWrited Monopolar Electrosurgical End Effectors”. Many of such systems,however, have in the past been unable to generate the magnitude offorces required to effectively cut and fasten tissue.

FIGS. 19-46A illustrate example embodiments of robotic surgical systems.In some embodiments, the disclosed robotic surgical systems may utilizethe ultrasonic or electrosurgical instruments described herein. Thoseskilled in the art will appreciate that the illustrated robotic surgicalsystems are not limited to only those instruments described herein, andmay utilize any compatible surgical instruments. Those skilled in theart will further appreciate that while various embodiments describedherein may be used with the described robotic surgical systems, thedisclosure is not so limited, and may be used with any compatiblerobotic surgical system.

FIGS. 19-25 illustrate the structure and operation of several examplerobotic surgical systems and components thereof. FIG. 19 shows a blockdiagram of an example robotic surgical system 500. The system 500comprises at least one controller 508 and at least one arm cart 510. Thearm cart 510 may be mechanically coupled to one or more roboticmanipulators or arms, indicated by box 512. Each of the robotic arms 512may comprise one or more surgical instruments 514 for performing varioussurgical tasks on a patient 504. Operation of the arm cart 510,including the arms 512 and instruments 514 may be directed by aclinician 502 from a controller 508. In some embodiments, a secondcontroller 508′, operated by a second clinician 502′ may also directoperation of the arm cart 510 in conjunction with the first clinician502′. For example, each of the clinicians 502, 502′ may controldifferent arms 512 of the cart or, in some cases, complete control ofthe arm cart 510 may be passed between the clinicians 502, 502′. In someembodiments, additional arm carts (not shown) may be utilized on thepatient 504. These additional arm carts may be controlled by one or moreof the controllers 508, 508′. The arm cart(s) 510 and controllers 508,508′ may be in communication with one another via a communications link516, which may be any suitable type of wired or wireless communicationslink carrying any suitable type of signal (e.g., electrical, optical,infrared, etc.) according to any suitable communications protocol.Example implementations of robotic surgical systems, such as the system500, are disclosed in U.S. Pat. No. 7,524,320 which has been hereinincorporated by reference. Thus, various details of such devices willnot be described in detail herein beyond that which may be necessary tounderstand various embodiments of the claimed device.

FIG. 20 shows one example embodiment of a robotic arm cart 520. Therobotic arm cart 520 is configured to actuate a plurality of surgicalinstruments or instruments, generally designated as 522 within a workenvelope 527. Various robotic surgery systems and methods employingmaster controller and robotic arm cart arrangements are disclosed inU.S. Pat. No. 6,132,368, entitled “Multi-Component Telepresence Systemand Method”, the full disclosure of which is incorporated herein byreference. In various forms, the robotic arm cart 520 includes a base524 from which, in the illustrated embodiment, three surgicalinstruments 522 are supported. In various forms, the surgicalinstruments 522 are each supported by a series of manually articulatablelinkages, generally referred to as set-up joints 526, and a roboticmanipulator 528. These structures are herein illustrated with protectivecovers extending over much of the robotic linkage. These protectivecovers may be optional, and may be limited in size or entirelyeliminated in some embodiments to minimize the inertia that isencountered by the servo mechanisms used to manipulate such devices, tolimit the volume of moving components so as to avoid collisions, and tolimit the overall weight of the cart 520. Cart 520 will generally havedimensions suitable for transporting the cart 520 between operatingrooms. The cart 520 may be configured to typically fit through standardoperating room doors and onto standard hospital elevators. In variousforms, the cart 520 would preferably have a weight and include a wheel(or other transportation) system that allows the cart 520 to bepositioned adjacent an operating table by a single attendant.

FIG. 21 shows one example embodiment of the robotic manipulator 528 ofthe robotic arm cart 520. In the example shown in FIG. 21, the roboticmanipulators 528 may include a linkage 530 that constrains movement ofthe surgical instrument 522. In various embodiments, linkage 530includes rigid links coupled together by rotational joints in aparallelogram arrangement so that the surgical instrument 522 rotatesaround a point in space 532, as more fully described in issued U.S. Pat.No. 5,817,084, the full disclosure of which is herein incorporated byreference. The parallelogram arrangement constrains rotation to pivotingabout an axis 534 a, sometimes called the pitch axis. The linkssupporting the parallelogram linkage are pivotally mounted to set-upjoints 526 (FIG. 20) so that the surgical instrument 522 further rotatesabout an axis 534 b, sometimes called the yaw axis. The pitch and yawaxes 534 a, 534 b intersect at the remote center 536, which is alignedalong a shaft 538 of the surgical instrument 522. The surgicalinstrument 522 may have further degrees of driven freedom as supportedby manipulator 540, including sliding motion of the surgical instrument522 along the longitudinal instrument axis “LT-LT”. As the surgicalinstrument 522 slides along the instrument axis LT-LT relative tomanipulator 540 (arrow 534 c), remote center 536 remains fixed relativeto base 542 of manipulator 540. Hence, the entire manipulator 540 isgenerally moved to re-position remote center 536. Linkage 530 ofmanipulator 540 is driven by a series of motors 544. These motors 544actively move linkage 530 in response to commands from a processor of acontrol system. As will be discussed in further detail below, motors 544are also employed to manipulate the surgical instrument 522.

FIG. 22 shows one example embodiment of a robotic arm cart 520′ havingan alternative set-up joint structure. In this example embodiment, asurgical instrument 522 is supported by an alternative manipulatorstructure 528′ between two tissue manipulation instruments. Those ofordinary skill in the art will appreciate that various embodiments ofthe claimed device may incorporate a wide variety of alternative roboticstructures, including those described in U.S. Pat. No. 5,878,193, thefull disclosure of which is incorporated herein by reference.Additionally, while the data communication between a robotic componentand the processor of the robotic surgical system is primarily describedherein with reference to communication between the surgical instrument522 and the controller, it should be understood that similarcommunication may take place between circuitry of a manipulator, aset-up joint, an endoscope or other image capture device, or the like,and the processor of the robotic surgical system for componentcompatibility verification, component-type identification, componentcalibration (such as off-set or the like) communication, confirmation ofcoupling of the component to the robotic surgical system, or the like.

FIG. 23 shows one example embodiment of a controller 518 that may beused in conjunction with a robotic arm cart, such as the robotic armcarts 520, 520′ depicted in FIGS. 20-22. The controller 518 generallyincludes master controllers (generally represented as 519 in FIG. 23)which are grasped by the clinician and manipulated in space while theclinician views the procedure via a stereo display 521. A surgeon feedback meter 515 may be viewed via the display 521 and provide the surgeonwith a visual indication of the amount of force being applied to thecutting instrument or dynamic clamping member. The master controllers519 generally comprise manual input devices which preferably move withmultiple degrees of freedom, and which often further have a handle ortrigger for actuating instruments (for example, for closing graspingsaws, applying an electrical potential to an electrode, or the like).

FIG. 24 shows one example embodiment of an ultrasonic surgicalinstrument 522 adapted for use with a robotic surgical system. Forexample, the surgical instrument 522 may be coupled to one of thesurgical manipulators 528, 528′ described hereinabove. As can be seen inFIG. 24, the surgical instrument 522 comprises a surgical end effector548 that comprises an ultrasonic blade 550 and clamp arm 552, which maybe coupled to an elongated shaft assembly 554 that, in some embodiments,may comprise an articulation joint 556. FIG. 25 shows another exampleembodiment having an electrosurgical instrument 523 in place of theultrasonic surgical instrument 522. The surgical instrument 523comprises a surgical end effector 548 that comprises closable jaws 551A,551B having energy delivery surfaces 553A, 553B for engaging andproviding electrical energy to tissue between the jaws 551A, 551B. Atissue cutting element or knife 555 may be positioned at the distal endof an axially movable member 557 that may extend through the elongatedshaft assembly 554 to the instrument mounting portion 558. FIG. 26 showsone example embodiment of an instrument drive assembly 546 that may becoupled to one of the surgical manipulators 528, 528′ to receive andcontrol the surgical instruments 522, 523. The instrument drive assembly546 may also be operatively coupled to the controller 518 to receiveinputs from the clinician for controlling the instrument 522, 523. Forexample, actuation (e.g., opening and closing) of the clamp arm 552,actuation (e.g., opening and closing) of the jaws 551A, 551B, actuationof the ultrasonic blade 550, extension of the knife 555 and actuation ofthe energy delivery surfaces 553A, 553B, etc. may be controlled throughthe instrument drive assembly 546 based on inputs from the clinicianprovided through the controller 518. The surgical instrument 522 isoperably coupled to the manipulator by an instrument mounting portion,generally designated as 558. The surgical instruments 522 furtherinclude an interface 560 which mechanically and electrically couples theinstrument mounting portion 558 to the manipulator.

FIG. 27 shows another view of the instrument drive assembly of FIG. 26including the ultrasonic surgical instrument 522. FIG. 28 shows anotherview of the instrument drive assembly of FIG. 26 including theelectrosurgical instrument 523. The instrument mounting portion 558includes an instrument mounting plate 562 that operably supports aplurality of (four are shown in FIG. 26) rotatable body portions, drivendiscs or elements 564, that each include a pair of pins 566 that extendfrom a surface of the driven element 564. One pin 566 is closer to anaxis of rotation of each driven elements 564 than the other pin 566 onthe same driven element 564, which helps to ensure positive angularalignment of the driven element 564. The driven elements 564 and pints566 may be positioned on an adapter side 567 of the instrument mountingplate 562.

Interface 560 also includes an adaptor portion 568 that is configured tomountingly engage the mounting plate 562 as will be further discussedbelow. The adaptor portion 568 may include an array of electricalconnecting pins 570, which may be coupled to a memory structure by acircuit board within the instrument mounting portion 558. Whileinterface 560 is described herein with reference to mechanical,electrical, and magnetic coupling elements, it should be understood thata wide variety of telemetry modalities might be used, includinginfrared, inductive coupling, or the like.

FIGS. 29-31 show additional views of the adapter portion 568 of theinstrument drive assembly 546 of FIG. 26. The adapter portion 568generally includes an instrument side 572 and a holder side 574 (FIG.29). In various embodiments, a plurality of rotatable bodies 576 aremounted to a floating plate 578 which has a limited range of movementrelative to the surrounding adaptor structure normal to the majorsurfaces of the adaptor 568. Axial movement of the floating plate 578helps decouple the rotatable bodies 576 from the instrument mountingportion 558 when the levers 580 along the sides of the instrumentmounting portion housing 582 are actuated (See FIGS. 24, 25) Othermechanisms/arrangements may be employed for releasably coupling theinstrument mounting portion 558 to the adaptor 568. In at least oneform, rotatable bodies 576 are resiliently mounted to floating plate 578by resilient radial members which extend into a circumferentialindentation about the rotatable bodies 576. The rotatable bodies 576 canmove axially relative to plate 578 by deflection of these resilientstructures. When disposed in a first axial position (toward instrumentside 572) the rotatable bodies 576 are free to rotate without angularlimitation. However, as the rotatable bodies 576 move axially towardinstrument side 572, tabs 584 (extending radially from the rotatablebodies 576) laterally engage detents on the floating plates so as tolimit angular rotation of the rotatable bodies 576 about their axes.This limited rotation can be used to help drivingly engage the rotatablebodies 576 with drive pins 586 of a corresponding instrument holderportion 588 of the robotic system, as the drive pins 586 will push therotatable bodies 576 into the limited rotation position until the pins586 are aligned with (and slide into) openings 590.

Openings 590 on the instrument side 572 and openings 590 on the holderside 574 of rotatable bodies 576 are configured to accurately align thedriven elements 564 (FIGS. 27, 28) of the instrument mounting portion558 with the drive elements 592 of the instrument holder 588. Asdescribed above regarding inner and outer pins 566 of driven elements564, the openings 590 are at differing distances from the axis ofrotation on their respective rotatable bodies 576 so as to ensure thatthe alignment is not 33 degrees from its intended position.Additionally, each of the openings 590 may be slightly radiallyelongated so as to fittingly receive the pins 566 in the circumferentialorientation. This allows the pins 566 to slide radially within theopenings 590 and accommodate some axial misalignment between theinstrument 522, 523 and instrument holder 588, while minimizing anyangular misalignment and backlash between the drive and driven elements.Openings 590 on the instrument side 572 may be offset by about 90degrees from the openings 590 (shown in broken lines) on the holder side574, as can be seen most clearly in FIG. 31.

Various embodiments may further include an array of electrical connectorpins 570 located on holder side 574 of adaptor 568, and the instrumentside 572 of the adaptor 568 may include slots 594 (FIG. 31) forreceiving a pin array (not shown) from the instrument mounting portion558. In addition to transmitting electrical signals between the surgicalinstrument 522, 523 and the instrument holder 588, at least some ofthese electrical connections may be coupled to an adaptor memory device596 (FIG. 30) by a circuit board of the adaptor 568.

A detachable latch arrangement 598 may be employed to releasably affixthe adaptor 568 to the instrument holder 588. As used herein, the term“instrument drive assembly” when used in the context of the roboticsystem, at least encompasses various embodiments of the adapter 568 andinstrument holder 588 and which has been generally designated as 546 inFIG. 26. For example, as can be seen in FIG. 26, the instrument holder588 may include a first latch pin arrangement 600 that is sized to bereceived in corresponding clevis slots 602 provided in the adaptor 568.In addition, the instrument holder 588 may further have second latchpins 604 that are sized to be retained in corresponding latch clevises606 in the adaptor 568. See FIG. 30. In at least one form, a latchassembly 608 is movably supported on the adapter 568 and is biasablebetween a first latched position wherein the latch pins 600 are retainedwithin their respective latch clevis 602 and an unlatched positionwherein the second latch pins 604 may be into or removed from the latchclevises 606. A spring or springs (not shown) are employed to bias thelatch assembly into the latched position. A lip on the instrument side572 of adaptor 568 may slidably receive laterally extending tabs ofinstrument mounting housing 582.

As described the driven elements 564 may be aligned with the driveelements 592 of the instrument holder 588 such that rotational motion ofthe drive elements 592 causes corresponding rotational motion of thedriven elements 564. The rotation of the drive elements 592 and drivenelements 564 may be electronically controlled, for example, via therobotic arm 512, in response to instructions received from the clinician502 via a controller 508. The instrument mounting portion 558 maytranslate rotation of the driven elements 564 into motion of thesurgical instrument 522, 523.

FIGS. 32-34 show one example embodiment of the instrument mountingportion 558 showing components for translating motion of the drivenelements 564 into motion of the surgical instrument 522, 523. FIGS.32-34 show the instrument mounting portion with a shaft 538 having asurgical end effector 610 at a distal end thereof. The end effector 610may be any suitable type of end effector for performing a surgical taskon a patient. For example, the end effector may be configured to provideRF and/or ultrasonic energy to tissue at a surgical site. The shaft 538may be rotatably coupled to the instrument mounting portion 558 andsecured by a top shaft holder 646 and a bottom shaft holder 648 at acoupler 650 of the shaft 538.

In one example embodiment, the instrument mounting portion 558 comprisesa mechanism for translating rotation of the various driven elements 564into rotation of the shaft 538, differential translation of membersalong the axis of the shaft (e.g., for articulation), and reciprocatingtranslation of one or more members along the axis of the shaft 538(e.g., for extending and retracting tissue cutting elements such as 555,overtubes and/or other components). In one example embodiment, therotatable bodies 612 (e.g., rotatable spools) are coupled to the drivenelements 564. The rotatable bodies 612 may be formed integrally with thedriven elements 564. In some embodiments, the rotatable bodies 612 maybe formed separately from the driven elements 564 provided that therotatable bodies 612 and the driven elements 564 are fixedly coupledsuch that driving the driven elements 564 causes rotation of therotatable bodies 612. Each of the rotatable bodies 612 is coupled to agear train or gear mechanism to provide shaft articulation and rotationand clamp jaw open/close and knife actuation.

In one example embodiment, the instrument mounting portion 558 comprisesa mechanism for causing differential translation of two or more membersalong the axis of the shaft 538. In the example provided in FIGS. 32-34,this motion is used to manipulate articulation joint 556. In theillustrated embodiment, for example, the instrument mounting portion 558comprises a rack and pinion gearing mechanism to provide thedifferential translation and thus the shaft articulation functionality.In one example embodiment, the rack and pinion gearing mechanismcomprises a first pinion gear 614 coupled to a rotatable body 612 suchthat rotation of the corresponding driven element 564 causes the firstpinion gear 614 to rotate. A bearing 616 is coupled to the rotatablebody 612 and is provided between the driven element 564 and the firstpinion gear 614. The first pinion gear 614 is meshed to a first rackgear 618 to convert the rotational motion of the first pinion gear 614into linear motion of the first rack gear 618 to control thearticulation of the articulation section 556 of the shaft assembly 538in a left direction 620L. The first rack gear 618 is attached to a firstarticulation band 622 (FIG. 32) such that linear motion of the firstrack gear 618 in a distal direction causes the articulation section 556of the shaft assembly 538 to articulate in the left direction 620L. Asecond pinion gear 626 is coupled to another rotatable body 612 suchthat rotation of the corresponding driven element 564 causes the secondpinion gear 626 to rotate. A bearing 616 is coupled to the rotatablebody 612 and is provided between the driven element 564 and the secondpinion gear 626. The second pinion gear 626 is meshed to a second rackgear 628 to convert the rotational motion of the second pinion gear 626into linear motion of the second rack gear 628 to control thearticulation of the articulation section 556 in a right direction 620R.The second rack gear 628 is attached to a second articulation band 624(FIG. 33) such that linear motion of the second rack gear 628 in adistal direction causes the articulation section 556 of the shaftassembly 538 to articulate in the right direction 620R. Additionalbearings may be provided between the rotatable bodies and thecorresponding gears. Any suitable bearings may be provided to supportand stabilize the mounting and reduce rotary friction of shaft andgears, for example.

In one example embodiment, the instrument mounting portion 558 furthercomprises a mechanism for translating rotation of the driven elements564 into rotational motion about the axis of the shaft 538. For example,the rotational motion may be rotation of the shaft 538 itself. In theillustrated embodiment, a first spiral worm gear 630 coupled to arotatable body 612 and a second spiral worm gear 632 coupled to theshaft assembly 538. A bearing 616 (FIG. 17) is coupled to a rotatablebody 612 and is provided between a driven element 564 and the firstspiral worm gear 630. The first spiral worm gear 630 is meshed to thesecond spiral worm gear 632, which may be coupled to the shaft assembly538 and/or to another component of the instrument 522, 523 for whichlongitudinal rotation is desired. Rotation may be caused in a clockwise(CW) and counter-clockwise (CCW) direction based on the rotationaldirection of the first and second spiral worm gears 630, 632.Accordingly, rotation of the first spiral worm gear 630 about a firstaxis is converted to rotation of the second spiral worm gear 632 about asecond axis, which is orthogonal to the first axis. As shown in FIGS.32-33, for example, a CW rotation of the second spiral worm gear 632results in a CW rotation of the shaft assembly 538 in the directionindicated by 634CW. A CCW rotation of the second spiral worm gear 632results in a CCW rotation of the shaft assembly 538 in the directionindicated by 634CCW. Additional bearings may be provided between therotatable bodies and the corresponding gears. Any suitable bearings maybe provided to support and stabilize the mounting and reduce rotaryfriction of shaft and gears, for example.

In one example embodiment, the instrument mounting portion 558 comprisesa mechanism for generating reciprocating translation of one or moremembers along the axis of the shaft 538. Such translation may be used,for example to drive a tissue cutting element, such as 555, drive anovertube for closure and/or articulation of the end effector 610, etc.In the illustrated embodiment, for example, a rack and pinion gearingmechanism may provide the reciprocating translation. A first gear 636 iscoupled to a rotatable body 612 such that rotation of the correspondingdriven element 564 causes the first gear 636 to rotate in a firstdirection. A second gear 638 is free to rotate about a post 640 formedin the instrument mounting plate 562. The first gear 636 is meshed tothe second gear 638 such that the second gear 638 rotates in a directionthat is opposite of the first gear 636. In one example embodiment, thesecond gear 638 is a pinion gear meshed to a rack gear 642, which movesin a liner direction. The rack gear 642 is coupled to a translatingblock 644, which may translate distally and proximally with the rackgear 642. The translation block 644 may be coupled to any suitablecomponent of the shaft assembly 538 and/or the end effector 610 so as toprovide reciprocating longitudinal motion. For example, the translationblock 644 may be mechanically coupled to the tissue cutting element 555of the RF surgical device 523. In some embodiments, the translationblock 644 may be coupled to an overtube, or other component of the endeffector 610 or shaft 538.

FIGS. 35-37 illustrate an alternate embodiment of the instrumentmounting portion 558 showing an alternate example mechanism fortranslating rotation of the driven elements 564 into rotational motionabout the axis of the shaft 538 and an alternate example mechanism forgenerating reciprocating translation of one or more members along theaxis of the shaft 538. Referring now to the alternate rotationalmechanism, a first spiral worm gear 652 is coupled to a second spiralworm gear 654, which is coupled to a third spiral worm gear 656. Such anarrangement may be provided for various reasons including maintainingcompatibility with existing robotic systems 500 and/or where space maybe limited. The first spiral worm gear 652 is coupled to a rotatablebody 612. The third spiral worm gear 656 is meshed with a fourth spiralworm gear 658 coupled to the shaft assembly 538. A bearing 760 iscoupled to a rotatable body 612 and is provided between a driven element564 and the first spiral worm gear 738. Another bearing 760 is coupledto a rotatable body 612 and is provided between a driven element 564 andthe third spiral worm gear 652. The third spiral worm gear 652 is meshedto the fourth spiral worm gear 658, which may be coupled to the shaftassembly 538 and/or to another component of the instrument 522, 523 forwhich longitudinal rotation is desired. Rotation may be caused in a CWand a CCW direction based on the rotational direction of the spiral wormgears 656, 658. Accordingly, rotation of the third spiral worm gear 656about a first axis is converted to rotation of the fourth spiral wormgear 658 about a second axis, which is orthogonal to the first axis. Asshown in FIGS. 36 and 37, for example, the fourth spiral worm gear 658is coupled to the shaft 538, and a CW rotation of the fourth spiral wormgear 658 results in a CW rotation of the shaft assembly 538 in thedirection indicated by 634CW. A CCW rotation of the fourth spiral wormgear 658 results in a CCW rotation of the shaft assembly 538 in thedirection indicated by 634CCW. Additional bearings may be providedbetween the rotatable bodies and the corresponding gears. Any suitablebearings may be provided to support and stabilize the mounting andreduce rotary friction of shaft and gears, for example.

Referring now to the alternate example mechanism for generatingreciprocating translation of one or more members along the axis of theshaft 538, the instrument mounting portion 558 comprises a rack andpinion gearing mechanism to provide reciprocating translation along theaxis of the shaft 538 (e.g., translation of a tissue cutting element 555of the RF surgical device 523). In one example embodiment, a thirdpinion gear 660 is coupled to a rotatable body 612 such that rotation ofthe corresponding driven element 564 causes the third pinion gear 660 torotate in a first direction. The third pinion gear 660 is meshed to arack gear 662, which moves in a linear direction. The rack gear 662 iscoupled to a translating block 664. The translating block 664 may becoupled to a component of the device 522, 523, such as, for example, thetissue cutting element 555 of the RF surgical device and/or an overtubeor other component which is desired to be translated longitudinally.

FIGS. 38-42 illustrate an alternate embodiment of the instrumentmounting portion 558 showing another alternate example mechanism fortranslating rotation of the driven elements 564 into rotational motionabout the axis of the shaft 538. In FIGS. 38-42, the shaft 538 iscoupled to the remainder of the mounting portion 558 via a coupler 676and a bushing 678. A first gear 666 coupled to a rotatable body 612, afixed post 668 comprising first and second openings 672, first andsecond rotatable pins 674 coupled to the shaft assembly, and a cable 670(or rope). The cable is wrapped around the rotatable body 612. One endof the cable 670 is located through a top opening 672 of the fixed post668 and fixedly coupled to a top rotatable pin 674. Another end of thecable 670 is located through a bottom opening 672 of the fixed post 668and fixedly coupled to a bottom rotating pin 674. Such an arrangement isprovided for various reasons including maintaining compatibility withexisting robotic systems 500 and/or where space may be limited.Accordingly, rotation of the rotatable body 612 causes the rotationabout the shaft assembly 538 in a CW and a CCW direction based on therotational direction of the rotatable body 612 (e.g., rotation of theshaft 538 itself). Accordingly, rotation of the rotatable body 612 abouta first axis is converted to rotation of the shaft assembly 538 about asecond axis, which is orthogonal to the first axis. As shown in FIGS.38-39, for example, a CW rotation of the rotatable body 612 results in aCW rotation of the shaft assembly 538 in the direction indicated by634CW. A CCW rotation of the rotatable body 612 results in a CCWrotation of the shaft assembly 538 in the direction indicated by 634CCW.Additional bearings may be provided between the rotatable bodies and thecorresponding gears. Any suitable bearings may be provided to supportand stabilize the mounting and reduce rotary friction of shaft andgears, for example.

FIGS. 43-46A illustrate an alternate embodiment of the instrumentmounting portion 558 showing an alternate example mechanism fordifferential translation of members along the axis of the shaft 538(e.g., for articulation). For example, as illustrated in FIGS. 43-46A,the instrument mounting portion 558 comprises a double cam mechanism 680to provide the shaft articulation functionality. In one exampleembodiment, the double cam mechanism 680 comprises first and second camportions 680A, 680B. First and second follower arms 682, 684 arepivotally coupled to corresponding pivot spools 686. As the rotatablebody 612 coupled to the double cam mechanism 680 rotates, the first camportion 680A acts on the first follower arm 682 and the second camportion 680B acts on the second follower arm 684. As the cam mechanism680 rotates the follower arms 682, 684 pivot about the pivot spools 686.The first follower arm 682 may be attached to a first member that is tobe differentially translated (e.g., the first articulation band 622).The second follower arm 684 is attached to a second member that is to bedifferentially translated (e.g., the second articulation band 624). Asthe top cam portion 680A acts on the first follower arm 682, the firstand second members are differentially translated. In the exampleembodiment where the first and second members are the respectivearticulation bands 622 and 624, the shaft assembly 538 articulates in aleft direction 620L. As the bottom cam portion 680B acts of the secondfollower arm 684, the shaft assembly 538 articulates in a rightdirection 620R. In some example embodiments, two separate bushings 688,690 are mounted beneath the respective first and second follower arms682, 684 to allow the rotation of the shaft without affecting thearticulating positions of the first and second follower arms 682, 684.For articulation motion, these bushings reciprocate with the first andsecond follower arms 682, 684 without affecting the rotary position ofthe jaw 902. FIG. 46 shows the bushings 688, 690 and the dual camassembly 680, including the first and second cam portions 680B, 680B,with the first and second follower arms 682, 684 removed to provide amore detailed and clearer view.

In various embodiments, the instrument mounting portion 558 mayadditionally comprise internal energy sources for driving electronicsand provided desired ultrasonic and/or RF frequency signals to surgicaltools. FIGS. 46B-46C illustrate one embodiment of a tool mountingportion 558′ comprising internal power and energy sources. For example,surgical instruments (e.g., instruments 522, 523) mounted utilizing thetool mounting portion 558′ need not be wired to an external generator orother power source. Instead, the functionality of the various generators20, 320 described herein may be implemented on board the mountingportion 558.

As illustrated in FIGS. 46B-46C, the instrument mounting portion 558′may comprise a distal portion 702. The distal portion 702 may comprisevarious mechanisms for coupling rotation of drive elements 592 to endeffectors of the various surgical instruments 522, 523, for example, asdescribed herein above. Proximal of the distal portion 702, theinstrument mounting portion 558′ comprises an internal direct current(DC) energy source and an internal drive and control circuit 704. In theillustrated embodiment, the energy source comprises a first and secondbattery 706, 708. In other respects, the tool mounting portion 558′ issimilar to the various embodiments of the tool mounting portion 558described herein above.

The control circuit 704 may operate in a manner similar to thatdescribed above with respect to generators 20, 320. For example, when anultrasonic instrument 522 is utilized, the control circuit 704 mayprovide an ultrasonic drive signal in a manner similar to that describedabove with respect to generator 20. Also, for example, when an RFinstrument 523 or ultrasonic instrument 522 capable of providing atherapeutic or non-therapeutic RF signal is used, the control circuit704 may provide an RF drive signal, for example, as described hereinabove with respect to the module 23 of generator 20 and/or the generator300. In some embodiments, the control circuit 704 may be configured in amanner similar to that of the control circuit 440 described herein abovewith respect to FIGS. 18B-18C.

Various embodiments described herein comprise an articulatable shaft.When using an articulatable shaft, components running through the shaftfrom the end effector must be flexible, so as to flex when the shaftarticulates. In various embodiments, this can be accomplished byutilizing waveguides that have flexible portions. For example, FIG. 47illustrates a schematic cross-sectional view of a portion of one exampleembodiment of an ultrasonic medical instrument 1500 comprising first,second and third waveguide portions. In FIG. 47, the hand piece and thesheath-articulation control knobs, etc. of the ultrasonic medicalinstrument 1500 are omitted for clarity. In the example embodiment shownin FIG. 47, the ultrasonic medical instrument 1500 comprises a medicalultrasonic waveguide 1502 for transmitting ultrasonic energy from atransducer (not shown in FIG. 47) to an ultrasonic blade 1544. Themedical ultrasonic waveguide 1502 has a length and includes first,second and third waveguide portions 1504, 1506 and 1508. The secondwaveguide portion 1506 is located lengthwise between the first and thirdwaveguide portions 1504 and 1508; the first waveguide portion 1504 islocated proximal the second waveguide portion 1506; and the thirdwaveguide portion 1508 is located distal the second waveguide portion1506. The first and third waveguide portions 1504 and 1508 each have alarger transverse area and the second waveguide portion 1506 has asmaller transverse area. The second waveguide portion 1506 is morebendable than either of the first and third waveguide portions 1504 and1508. It is further noted that ultrasonic vibration can be any one, orany combination, of longitudinal, transverse, and torsional vibration.In some embodiments, the section 1506 may have a circular cross-section(e.g., a uniform cross-sectional radius).

In some embodiments the second bendable waveguide portion 1506 may nothave a uniform cross-sectional radius. For example, FIG. 47A illustratescross sections for two example embodiments of the waveguide portion1506. The waveguide portion 1506′ is illustrated in relation to two axes1509, 1511, also shown in FIG. 47. In various embodiments, the waveguideportion 1506′ may have a cross sectional length along axis 1511 that isless than its cross sectional dimension along axis 1509. In someembodiments, the cross sectional length along the axis 1509 may be equalto the cross sectional length of the other waveguide portions 1504,1506. The waveguide portion 1506′ may be bendable along the axis 1509.Referring now to waveguide portion 1506″, its cross sectional lengthsalong the axis 1509, 1511 may be the same, providing the waveguideportion 1506″ with a greater range of directions for bending.

In some example embodiments, the medical ultrasonic waveguide 1502 is amonolithic (e.g., the blade portion 1544 is integral to the waveguide1502). Also, in some example embodiments, the medical ultrasonicwaveguide 1502 includes first and second longitudinal vibrationantinodes 1510 and 1512. The first waveguide portion 1504 may transitionto the second waveguide portion 1506 proximate the first longitudinalvibration antinode 1510; and the second waveguide portion 1506 maytransition to the third waveguide portion 1508 proximate the secondlongitudinal vibration antinode 1512. In some example embodiments, asillustrated by FIG. 47, the second waveguide portion 1506 issubstantially ½ of a resonant-longitudinal-wavelength long.

In one example application of the embodiment of FIG. 47, the ultrasonicmedical instrument 1500 also includes a user-actuated articulated sheath1514 which surrounds the medical ultrasonic waveguide 1502. In variousexample embodiments, the medical ultrasonic waveguide 1502 includesthree (meaning at least three) longitudinal vibration nodes 1516located, one each, on the first, second and third waveguide portions1504, 1506 and 1508. It is noted that one or more additionallongitudinal vibration nodes may, or may not, be present between any oneor two of the three longitudinal vibration nodes 1516. In onemodification, the sheath 1514 contacts (e.g., directly contacts orindirectly contacts through at least one intervening member 1517 such asa silicone intervening member) the first, second and third waveguideportions 1504, 1506 and 1508 at a corresponding one of the threelongitudinal vibration nodes 1516. In one example, the sheath 1514includes a rigid first sheath portion 1518 contacting the firstwaveguide portion 1504 at the first longitudinal vibration node (theleftmost node 1516 of FIG. 47), a flexible second sheath portion 1520contacting the second waveguide portion 1506 at the second longitudinalvibration node (the middle node 1516 of FIG. 47), and a rigid thirdsheath portion 1522 contacting the third waveguide portion 1508 at thethird longitudinal vibration node (the rightmost node 1516 of FIG. 47).In some example embodiments, the sheath 1514 has only two articulationpositions (e.g., straight and fully articulated). In other exampleembodiments, the sheath 1514 has a number of intermediate bent positionsbetween a straight position and a fully articulated position dependingon the number of energy efficient curves the waveguide 1502 can beformed to. In some example embodiments, such energy efficient curvesminimize vibrational energy going into non-longitudinal vibrationalmodes.

FIG. 48 illustrates a schematic cross-sectional view of a portion of oneexample embodiment of an ultrasonic medical instrument 1524 comprisingfirst and second waveguide portions 1530, 1532, where the firstwaveguide portion 1530 spans multiple ½ resonant longitudinalwavelengths. In the example embodiment show in FIG. 48, a medicalultrasonic waveguide 1526 includes at least two longitudinal vibrationnodes 1528 located on the first waveguide portion 1530. In onevariation, a sheath 1534 contacts (e.g., directly contacts or indirectlycontacts through at least one intervening member 1536 such as a siliconeintervening member) the first waveguide portion 1530 at the at-least-twolongitudinal vibration nodes 1528. In some example embodiments, thesheath 1534 includes two rigid sheath portions 1538 and 1542 and oneflexible sheath portion 1540, wherein the flexible sheath portion 1540contacts the first waveguide portion 1530 at least one of the twolongitudinal vibration nodes 1528, and wherein the flexible sheathportion 1540 is disposed between the two rigid sheath portions 1538 and1542. In one example embodiment, the two rigid sheath portions 1538 and1542 each contact the second waveguide portion 1532 at a correspondingone of the at-least-two longitudinal vibration nodes 1528.

Referring now to FIG. 47, the waveguide 1502 may comprise a bladeportion 1544 adapted to contact and ultrasonically treat patient tissue.The blade portion 1544 may be disposed at a distal end of the waveguide1502 (e.g., distal of the third blade portion 1508 of the blade 1502).In one example embodiment, the surgical instrument 1500 may alsocomprise a user-actuated clamp arm 1546 pivotally attached to the sheath1514, 1534 proximate the blade portion 1544, wherein the clamp arm 1546and the medical ultrasonic waveguide 1502 at least in part define anultrasonic surgical shears 1548. The tissue pad and clamping arm controlmechanism has been omitted from FIG. 47. Referring again to FIG. 48, themedical ultrasonic waveguide 1526 may also comprise a blade portion1545, similar to the blade portion 1544, and disposed at a distal end ofthe first waveguide portion 1532. The blade portion 1545 may also beadapted to contact and ultrasonically treat patient tissue. Theinstrument 1524 of FIG. 48 may also comprise a clamp arm 1546, defining,with the blade portion 1545, an ultrasonic surgical shears 1548.

In various example embodiments, certain portions of the waveguides 1502,1526 are substantially rigid. For example, first and third portions 1504and 1508 of the waveguide 1502 may be substantially rigid. The firstportion 1532 of the waveguide 1526 may be substantially rigid. Referringagain to FIG. 47, the medical ultrasonic waveguide 1502 may includefirst and second neck portions 1550 and 1552 joining, respectively, thefirst and second waveguide portions 1504 and 1506 and the second andthird waveguide portions 1506 and 1508. (A similar neck portion 1552 mayjoin the first and second waveguide portions 1530, 1532 of the waveguide1526.)

In one modification, the medical ultrasonic waveguide 1502 issubstantially cylindrical from the first waveguide portion 1504 to thethird waveguide portion 1508, wherein the first, second and thirdwaveguide portions 1504, 1506 and 1508 each have a substantiallyconstant diameter, and wherein the diameter of the second waveguideportion 1506 is smaller than the diameter of either of the first andthird waveguide portions 1504 and 1508. In some example embodiments, thediameter of the second waveguide portion 1506 is between substantiallyone and two millimeters, and the diameter of the first and thirdwaveguide portions is between substantially three and five millimeters.In one choice of materials, the medical ultrasonic waveguide 1502consists essentially of a titanium alloy. In one modification, themedical ultrasonic waveguide 1502 includes first and second longitudinalvibration antinodes 1510 and 1512, and the first neck portion 1550 isdisposed proximate the first longitudinal vibration antinode 1510 andthe second neck portion 1552 is disposed proximate the secondlongitudinal vibration antinode 1512.

FIG. 49 illustrates a schematic cross-sectional view of one exampleembodiment of an ultrasonic waveguide 1554 for use with a medicalinstrument and comprising first and second waveguide portions, where afirst waveguide portion 1556 is joined to a second waveguide portion1558 by a dowel press fit. In the example illustrated in FIG. 49, thesecond waveguide portion 1558 is also coupled to a third waveguideportion 1560 by a dowel press fit. In various example embodiments, thesecond waveguide portion 1558 consists essentially of titanium ornitinol. In the same or a different illustration, the length of thesecond waveguide portion 1558 is less than ½ wavelength (a wavelengthbeing the length of a resonant-longitudinal-wavelength of the medicalultrasonic waveguide which depends essentially on the material of thewaveguide and the frequency at which it is run) and in one example isless than ⅛ wave.

FIG. 50 illustrates a schematic cross-sectional view of one exampleembodiment of an ultrasonic waveguide 1564 for use with a medicalinstrument. Like the waveguide 1554, the waveguide 1564 is not amonolithic waveguide. The waveguide 1564 may comprise first and secondwaveguide portions 1564, 1566, where the first waveguide portion 1564 isjoined to the second waveguide 1566 portion by a ball-and-socket typeattachment. The second waveguide portion 1566 may also be joined to athird waveguide portion 1568 in any suitable manner. In the example ofFIG. 50, the second waveguide portion 1566 is joined to the thirdwaveguide portion 1568 via a dowel press fit. Other attachments betweenwaveguide portions are left to those skilled in the art.

FIG. 51 illustrates a schematic cross-sectional view of a portion ofanother embodiment of an ultrasonic medical instrument 1570 comprising amedical ultrasonic waveguide 1572 having a length and including aproximal waveguide portion 1574 and a distal waveguide portion 1576. Theproximal waveguide portion 1574 has a larger transverse area and thedistal waveguide portion 1576 has a smaller transverse area. The distalwaveguide portion 1576 bends more easily than does the proximalwaveguide portion 1574. The distal waveguide portion 1576 includes adistal end portion 1580 adapted to contact and ultrasonically treatpatient tissue. In various example embodiments, the additional ½ waveneeded to neck up and create the larger diameter end effector of theembodiment of FIG. 47 is eliminated making it possible to place thearticulation joint closer to the distal end of the ultrasonic medicalinstrument 1570. The embodiments, applications, etc. shown in FIGS.47-50 are equally applicable (without the presence of the thirdwaveguide portion) to the embodiment of FIG. 51.

FIG. 52 illustrates one embodiment of a shaft 1000 that may be utilizedwith various surgical instruments, including those described herein. Anend effector 1006 is positioned within a shaft body 1004 and maycomprise an ultrasonic blade 1008. The ultrasonic blade 1008 may beacoustically coupled to a waveguide 1020 extending proximally from theblade 1008. The waveguide 1020 may comprise a bendable portion 1012,such as the bendable portions 1506, 1530, 1576, etc., described hereinabove. Also positioned within the shaft 1000 is a wedge 1016 coupled toa translating cable 1018 that extends proximally from the wedge 1016.The wedge 1016 may reciprocate proximally and distally under the controlof the cable 1018. The cable 1018 may be made of any suitable materialincluding, for example, a material that is rigid enough to provide adistally directed force on the wedge 1016 when the cable 1018 is pusheddistally (e.g., from a handle, from a robotic instrument mountingportion, etc.). In some embodiments, the cable 1018 may be made from ametal material.

The ultrasonic waveguide 1020 may be coupled to the shaft body 1004 at apivot point 1014. For example, the pivot point 1014 may represent a pinreceived through the waveguide 1020 to hold the waveguide stationaryrelative to the shaft body 1004 at about the pivot point 1014. The pivotpoint may be located proximally from the bendable portion 1012. Distalof the bendable portion 1012 of the waveguide 1020, the waveguide 1020and/or ultrasonic blade 1008 defines a flange 1010. As the wedge 1016 istranslated distally, it may come into contact with the flange 1010. Asthe flange 1010 rides up the wedge 1016, the waveguide 1020 may pivotabout the pivot point, tending to pivot the blade 1008 and waveguide1020 away from a longitudinal axis 1002 of the shaft 1000. FIG. 53illustrates one embodiment of the shaft 1000, with the wedge 1016translated distally and the blade 1008 pivoted, as described. Proximaltranslation of the wedge 1016 from the position shown in FIG. 53 mayrelease the force on the flange 1010 tending to cause deflection of theblade 1008. Absent the force, the blade 1008 and waveguide 1020 mayreturn to the resting position illustrated in FIG. 52. For example, theblade 1008 and/or waveguide 1020 may be constructed from a resilientmaterial that regains its original shape after bending. For example, invarious embodiments, the wedge 1016 may not push the blade 1008 and/orthe waveguide 1020 past their respective points of plasticity. Theflange 1010 and pivot point 1014 may both be positioned at nodes of thewaveguide 1020 (e.g., portions where there is substantially no movementof the waveguide 1020). In some embodiments, the flange 1010 and pivotpoint 1014 may be separated by a single wavelength.

The wedge 1016 and cable 1018 may be translated distally and proximallyaccording to any suitable method or mechanism. For example, when theshaft 1000 is used in conjunction with a manual or hand held surgicalinstrument, the cable 1018 may be translated distally and proximally ina manner similar to that described herein above with respect to thereciprocating tubular actuating member 58 of the instrument 10 and/orthe axially moving member 378 of the instrument 300. Also, for example,when the shaft 1000 is used in conjunction with a surgical robot, thecable 1018 may be translated distally and proximally in a manner similarto that described above with respect to the tissue cutting element 555of the instrument 310.

FIG. 54 illustrates an alternative embodiment of the shaft 1000comprising several additional features. For example, the shaft 1000, asillustrated in FIG. 54 comprises an optional second wedge 1016′ andcable 1018′. The second wedge 1016′ and cable 1018′ may operate similarto the wedge 1016 and cable 1018 described herein above. The secondwedge 1016′ and cable 1018′, however, may be offset from the first wedge1016 and cable 1018 about the longitudinal axis such that distaltranslation of the first wedge 1016 causes the end effector 1008 andwaveguide 1020 to pivot in a first direction and distal translation ofthe second wedge 1016′ causes the end effector 1008 and waveguide 1020to pivot in a second direction. In various example embodiments, thefirst and second directions may be 180° opposed from one another aboutthe longitudinal axis. In the example embodiment illustrated in FIG. 54,the shaft body 1004 also comprises slots 1022, 1022′ for receiving slotmembers 1024, 1024′ of the respective wedges 1016, 1016′. The slots1022, 1022′ and slot members 1024, 1024′ may serve to maintain axiallyalignment of the respective wedges 1016, 1016′.

FIG. 54 also illustrates one example mechanism for translating thewedges 1016, 1016′ and cables 1018, 1018′ distally and proximally (e.g.,in a robotic surgical embodiment). For example, each cable 1018, 1018′may be wound around respective spools 1026, 1026′. The spools 1026,1026′, in turn, may be coupled to a robotically controlled componentsuch as, for example, respective rotatable bodies 612 as describedherein. Clockwise and counter clockwise rotation of the spools 1026,1026′ may wind and unwind the cables 1018, 1018′ providing alternatingdistal and proximally translation to the wedges 1016, 1016′.

The wedges 1016, 1016′ of FIGS. 52-54 are shown in two dimensions.Wedges according to various embodiments, however, can have differentthree dimensional shapes. FIG. 55 illustrates one embodiment of anexample wedge 1028 having a curved or rounded shape. A cross-section1030 of the wedge 1028 shows a wedge face portion 1032 for contactingthe flange 1010. The arrow 1032 indicates a distal direction along thelongitudinal axis 1002. FIG. 56 illustrates the wedge 1028 inconjunction with an end effector 1006 comprising an ultrasonic blade1008 as well as a flange 1010.

FIG. 57 illustrates a cross-section of one embodiment of the shaft 1000showing a keyed flange 1010′. The flange 1010′ comprises a first keyedsurface 1038 for receiving a keyed wedge. The keyed surface 1038 definesfirst, second and third notches 1036, 1038, 1040 for receiving a stepsof a correspondingly keyed wedge. FIG. 58 illustrates one embodiment ofa keyed wedge 1044 comprising steps 1046, 1048, 1050 matching thenotches 1036, 1038, 1040 of the keyed flange 1010′. In variousembodiments, the longitudinal slopes of the various steps 1046, 1048,1050 are equal. The keyed flange 1010′ is also illustrated with anoptional second keyed surface 1042, for example, for interfacing with asecond keyed wedge (not shown) in a multi-wedge embodiment such as thatshown in FIG. 54. Also, although three notches 1036, 1038, 1040 andthree steps 1046, 1048, 1050 are shown, it will be appreciated thatkeyed surfaces 1038 and wedges 1044 may have more or fewer notches andsteps.

FIG. 59 illustrates a wedge 1052 for use with the shaft 1000, the wedge1052 having a stepped profile. The stepped profile may allow the wedge1052 to pivot the ultrasonic blade 1008 and waveguide 1020 by discreteamounts. For example, as the wedge 1052 is translated distally, a firstwedge portion 1054 pushes the flange 1010, pivoting the blade 1008 andwaveguide 1020 by a first amount. As the flange 1010 reaches a firstflat portion 1056, it may be held, pivoted by the first amount, untilthe flange 1010 encounters a second wedge portion 1058. The second wedgeportion 1058 may pivot the blade 1008 and waveguide 1020 by a secondamount, which is again held as the flange 1010 slides across a secondflat portion 1060. A third wedge portion 1062 and third flat portion1064 may operate in a similar fashion as the wedge 1052 continues totranslate distally. When the wedge 1052 is retracted proximally, theflange 1010 (and therefore the blade 1008 and waveguide 1020) maytransition back through the discrete pivot amounts associated with eachwedge portion and flat portion pair.

FIG. 60 illustrates one example embodiment of a shaft 1066 for use withvarious surgical instruments, including those described herein having acammed articulation mechanism. Positioned within the shaft 1066 is awaveguide 1020 coupled to the shaft 1066 at a pivot point 1014. Thewaveguide 1020 is acoustically coupled to an ultrasonic blade 1008, asdescribed above. The flange 1068 may be a cammed flange defining awaveguide cam feature 1072 configured to contact a shaft cam feature1070 to deflect the waveguide 1020 and blade 1008 about the pivot point1012. FIG. 61 illustrates a cross-sectional view of the shaft 1066providing a view of the shaft cam feature 1070 and waveguide cam feature1072. In various example embodiments, the shaft body 1004 may berotatable about the longitudinal axis 1002. As the shaft body 1004rotates, the shaft cam feature 1070 may come into contact with thewaveguide cam feature 1072, causing the waveguide 1020 and blade 1008 topivot about the pivot point 1014 away from the shaft cam feature 1070.

In some example embodiments, as illustrated in FIG. 61, the flange 1068may define additional waveguide cam features 1074, 1076, 1078 that mayoperate in a manner similar to the waveguide cam feature 1072. Forexample, as the shaft body 1004 rotates, the shaft cam feature 1070 may,in turn, contact each of the additional waveguide cam features 1074,1076, 1078, causing the waveguide 1020 and blade 1008 to pivot away fromthe shaft cam feature 1070 about the pivot point 1014. In variousembodiments, the shaft body 1004 may define additional shaft camfeatures (not shown). The shaft body 1004 may be rotated in any suitablemanner. For example, in manual or hand-operated surgical instruments,the shaft body 1004 may be rotated in a manner similar to that describedabove with respect to the distal rotation assembly 13 and shaft assembly14. In robotic surgical instruments, for example, the shaft body 1004may be rotated in a manner similar to those described above with respectto FIGS. 32-46C. Also, FIG. 60 illustrates another embodiment forrotating the shaft body 1004, for example, in a robotic setting. Forexample, a proximal end of the shaft body 1004 may comprise first andsecond spools 1085, 1087. Additional spools 1081, 1083 are positioned tobe rotated by a robot (e.g., the spools 1081, 1083 may be coupled torotatable bodies 612, as described herein. A cable 1093 may be woundaround spools 1085 and 1081. Similarly, a cable 1091 may be wound aroundspools 1083, 1087. Rotation of spool 1081 may cause the cable 1093 towind off of the spool 1085 to the spool 1081, thereby rotating the shaftbody 1004 in a first direction. The shaft rotation in the firstdirection may also cause cable 1091 to wind off of spool 1083 and ontospool 1087. In some embodiments, spool 1083 may be separately driven tofacilitate this winding. To rotate the shaft body 1004 in a directionopposite the first direction, the spool 1083 may be rotated in anopposite direction, causing cable 1091 to wind from the spool 1087 tothe spool 1093. At the same time, spool 1085 may draw cable 1093 fromspool 1081. Again, spool 1081 may be separated driven to facilitate thiswinding.

FIG. 62-64 illustrates one embodiment of an articulating shaft 1080 thatmay be utilized with various surgical instruments, including thosedescribed herein. The shaft body 1004 comprises an interior wall 1092defining a groove 1082. The groove 1082 may have different portionspositioned at different axial distances from the end effector 1006. Forexample, in some example embodiments, the groove 1082 may be an ovaloid.Also, in some example embodiments, as illustrated by FIGS. 62-64, thegroove 1082 may represent a partial or complete cross-section of theshaft body 1004 taken in a plane that intersects the longitudinal axis1002, but is not perpendicular to the axis 1002.

The flange 1010 of the waveguide 1020 (and/or end effector 1006) may becoupled to a pair of interface members 1084, 1086 at a coupling point(represented in FIGS. 62-64 as the flange 1010). A first interfacemember 1084 may extend proximally from the flange 1010 and may compriseand/or define a first peg member 1088 positioned to ride within thegroove 1082. A second interface member 1084 may extend proximally fromthe flange 1010 and, similarly, may comprise and/or define a second pegmember 1090 also positioned to ride within the groove 1082. Asillustrated, the length of the first interface member 1084 between theflange 1010 and the first peg 1088 is longer than the length of thesecond interface member 1086 between the flange 1010 and the second peg1090, although this is not necessary.

In the example embodiment shown in FIGS. 62-64, the end effector 1006 ispivoted away from the longitudinal axis 1002 by rotating the shaft body1004 relative to the waveguide 1020, blade 1008 and interface members1084, 1086. This relative rotation be brought about by rotation of theshaft body 1004, rotation of the waveguide 1020, or both. As therelative rotation takes place, the peg members 1088, 1090 may ridewithin the groove 1082. As the peg members 1088, 1090 ride withinportions of the groove that are closer to and further from the endeffector 1006, the peg members 1088, 1090 may be pushed close to andfurther from the end effector 1006. Differential axial translation ofthe peg members 1088, 1090 may cause bending of the interface members1084, 1086, resulting in pivoting of the end effector 1006. For example,as illustrated in FIG. 64, the peg members 1088, 1090 are placed at aposition roughly equidistant from the end effector 1006. As theinterface member 1084 is longer than the interface member 1086 in theexample of FIG. 64, member 1084 may be pushed distally, while member1086 is pulled proximally. This may result in the pivoting of the endeffector 1006 away from the longitudinal axis 1002 as shown.

The shaft body 1004 and/or waveguide 1020 may be rotated in any suitablemanner. For example, in manual or hand-operated surgical instruments,the shaft body 1004 and/or waveguide 1020 may be rotated in a mannersimilar to that described above with respect to the distal rotationassembly 13 and shaft assembly 14. In robotic surgical instruments, forexample, the shaft body 1004 and/or waveguide 1020 may be rotated in amanner similar to those described above with respect to FIGS. 32-46C.

FIGS. 65-67 illustrate one example embodiment of a shaft 1100 coupled toan end effector 1106 comprising an ultrasonic blade 1108 and a pivotableclamp arm 1110. The shaft 11102 comprises a proximal tube 1102 and aflexible portion 1104 with the end effector 1106 coupled to the flexibleportion 1104. A clamp arm 1110 is pivotably coupled to the end effector1106 (e.g., an end effector member 1107) at pivot point 1112. FIGS.66-67 are cut-away views showing components positioned inside of theshaft 1100. For example, a waveguide 1114 may be acoustically coupled tothe ultrasonic blade 1108 and may comprise a bendable portion 1116 atabout the position of the flexible portion 1104 of the shaft 1100.Articulation translating members 1113, 1115 may be coupled to the endeffector member 1107 at points 1126 and 1124, respectively, to bringabout articulation of the end effector 1106, as described below. A clamparm member 1117 may be coupled to the clamp arm 1110 and may translatedistally and proximally to open and close the clamp arm 1110, asdescribed herein below.

FIG. 68 illustrates one embodiment of the end effector 1106 illustratinga first way to utilize the clamp arm member 1117 to open and close theclamp arm 1110. As described above, the clamp arm 1110 may be pivotablycoupled to the end effector member 1107 at pivot point 1112. In theexample embodiments shown in FIG. 68, the clamp arm member 1117 is atranslating member that is coupled to the clamp arm 1110 at 1120. Distaltranslation of the clamp arm member 1117 may push the point 1120 of theclamp arm 1110 distally, causing the clamp arm 1110 to pivot about thepivot point 1112 to an open position (as illustrated by the dotted linesin FIG. 67). Alternately, pulling the clamp arm member 1117 proximallymay pull the point 1120 proximally, causing the clamp arm 1110 to pivotback to the closed position shown in FIGS. 65-66 and 68. The translatingclamp arm member 1117 may be translated distally and proximally in anysuitable manner. For example, when the shaft 1100 is used in conjunctionwith a manual or hand held surgical instrument, the translating member1117 may be translated distally and proximally in a manner similar tothat described herein above with respect to the reciprocating tubularactuating member 58 of the instrument 10 and/or the axially movingmember 378 of the instrument 300. Also, for example, when the shaft 1100is used in conjunction with a surgical robot, the translating member1117 may be translated distally and proximally in a manner similar tothat described above with respect to the tissue cutting element 555 ofthe instrument 310.

FIGS. 69-70 illustrate another example embodiment of the end effector1106 illustrating an additional way to utilize a clamp arm member 1117′to open and close the clamp arm 1110. The clamp arm member 1117′ may bea flexible, threaded cable defining a threaded portion 1130 that mayextend through a threaded hole 1134 of the end effector member 1107. Adistal portion of the clamp arm member 1117′ may be coupled to a mount1132 positioned distally from the pivot point 1112. As the clamp armmember 1117′ is rotated in a first direction, it may translate distally,pushing distally on the mount 1132 and clamp arm 1110 and tending toclose the clamp arm 1110. As the clamp arm member 1117′ is rotated in asecond direction opposite the first direction, it may translateproximally, pulling proximally on the mount 1132 and tending to open theclamp arm 1110. The clamp arm member 1117′ may be rotated in anysuitable manner. For example, in manual or hand-operated surgicalinstruments, the clamp arm member 1117′ may be rotated in a mannersimilar to that described above with respect to the distal rotationassembly 13 and shaft assembly 14. In robotic surgical instruments, forexample, the clamp arm member 1117′ may be rotated in a manner similarto those described above with respect to FIGS. 32-46C.

Referring now again to FIGS. 65-67, it will be appreciated thatarticulation of the end effector 1106 may be brought about in anysuitable manner. For example, when the translating member 1113 is pulledproximally, the end effector 1106 may pivot toward the translatingmember 1113 as shown in FIG. 65. Conversely, when the translating member1115 is pulled proximally, the end effector 1106 may pivot towards thetranslating member 1115.

FIGS. 71-72 illustrate one example embodiment of the shaft 1110 showingan example mechanism for managing differential translation of thetranslating members 1113, 1115. As shown in FIGS. 71-72, the translatingmembers may comprise and/or define respective rack gears 1138, 1136. Apinion gear 1140 may be positioned to engage both of the rack gears1138, 1136. When one of the translating members 1113 is translated alongthe longitudinal axis, rack gear 1138 may interface with the pinion gear1140 causing corresponding and oppositely-directed translation of theopposite translating member 1115, and visa versa. This may facilitatedifferential translation of the members 1113, 1115. In some embodiments,the pinion gear 1140 may be driven, either manually via a lever and/orautomatically (e.g., by a robotic surgical device). When the pinion gear1140 is driven, it may, in turn, drive rack gears 1138, 1136 causingdifferential proximal and distal translation of the translating members1113, 1115 and articulation of the end effector 1106.

Differential translation of the translating members 1113, 1115 may beaccomplished in any suitable manner. For example, when the shaft 1100 isutilized in the context of a surgical robot, the members 1170, 1172 maybe differentially translated utilizing any of the methods and/ormechanisms described herein above with respect to FIGS. 32-46C.Alternatively, FIGS. 73-74 illustrate one embodiment of a hand-heldsurgical instrument utilizing the shaft 1100 in the configuration shownin FIGS. 71-72. Pinion gear 1140 is shown in FIG. 73 as coupled to alever 1142 that may be rotated by a clinician to bring aboutarticulation of the end effector 1106, as described herein above. FIG.74 shows the instrument 1150 including the lever 1142, demonstratingplacement and use of the lever 1142 to bring about articulation.

FIGS. 75-76 illustrate one embodiment of an articulating shaft 1200 thatmay be utilized with various surgical instruments, including thosedescribed herein. The shaft 1200 comprises a distal tube 1202 pivotablycoupled to a proximal tube 1204 via a hinge interface 1208. The hingeinterface 1208 may be and/or comprise any suitable type of hinge andmay, in some example embodiments, comprise a pin. An inner rotatablemember 1206 may extend proximally through the proximal tube 1204 and atleast a portion of the distal tube 1202. The inner rotatable member 1206may define a slanted slot 1210. The distal tube 1202 may comprise a peg1212 positioned to ride within the slanted slot 1210.

The peg 1212, as illustrated, may be positioned opposite thelongitudinal axis 1002 from the hinge interface 1208. Due to the slantof the slot 1210, rotation of the inner rotatable member 1206 and slot1210 in a first direction may tend to push the peg 1212, and thereby thedistal tube 1202, distally. Rotation of the inner rotatable member 1206and slot 1210 in a second direction opposite the first direction maytend to pull the peg 1212 and distal tube 1202 proximally. When the peg1212 and distal tube 1202 are pushed distally by rotation of the member1206 and slot 1210, the distal tube 1202 may pivot about the hingeinterface 1208 away from the longitudinal axis 1002, as illustrated inFIG. 76. When the peg 1212 and distal tube 1202 are pulled proximally byrotation of the member 1206 and slot 1210, the distal tube 1202 maypivot back towards the longitudinal axis 1002 to the positionillustrated in FIG. 75. Rotation of the rotatable member 1206 may beactuated in any suitable manner. For example, in manual or hand-operatedsurgical instruments, the member 1206 may be rotated in a manner similarto that described above with respect to the distal rotation assembly 13and shaft assembly 14. In robotic surgical instruments, for example, themember 1206 may be rotated in a manner similar to those described abovewith respect to FIGS. 32-46C. It will be appreciated that the shaft 1200may be used with any suitable type of surgical instrument including, forexample, an ultrasonic surgical instrument, an electrosurgicalinstrument, etc. In some embodiments, wire, waveguides and/or othercontrol devices for a surgical instrument may pass through the proximaland distal tubes 1204, 1202. For example, in some embodiments, awaveguide extending through the proximal and distal tubes 1204, 1202 mayhave a bendable portion 1046, for example, similar to the bendableportions 1506, 1530, 1576, etc., described herein above. The bendableportion may be positioned at about the hinge interface 1208 so as tobend as the distal tube 1202 pivots.

FIG. 77 illustrates one embodiment of a shaft 1300 that may be utilizedwith various surgical instruments, including those described herein. Anend effector 1309 is positioned within an inner shaft 1322 and an outershaft 1302. The end effector 1309 comprises an ultrasonic blade 1303.Moving proximally, the blade 1303 is acoustically coupled to a flange1305 that extends through a slot 1312 in the outer shaft 1302. Theflange 1305 is coupled to a second flange 1306 via a bendable waveguideportion 1316 (e.g., similar to the bendable portions 1506, 1530, 1576described herein above). The second flange 1306 may be fixedly coupledto the inner shaft 1322 via supports 1308. The second flange 1306 andsupports 1308 may form pivot point 1304. The outer shaft 1302 defines aslot 1312 that receives the flange 1305. When the outer shaft 1302 istranslated distally relative to the inner shaft 1322, the flange 1305may reach a proximal-most portion of the slot 1312, causing the blade1303 to pivot about the pivot point 1304. The blade 1303 may return toits rest position when the outer shaft 1302 is pulled proximally again.In various embodiments, the respective flanges 1306, 1305 may bepositioned at nodes of the waveguide 1308 at the resonant wavelength ofthe system. In some embodiments, the flanges 1306, 1305 are separated bya single resonant wavelength.

The outer shaft 1302 may be translated distally and proximally in anysuitable manner. FIG. 78 illustrates a view showing additional detailsof one embodiment of the outer shaft 1302. In certain embodiments, theouter shaft 1302 biased distally by a spring 1310. Reciprocating controlmembers 1320 may be utilized to pull the outer shaft 1302 proximally,overcoming the bias of the spring 1310. When tension on the controlmembers 1320 is released, the spring 1310 may bias the outer shaftdistally, causing articulation as described above. The control members1320 may be translated distally and proximally in any suitable manner.For example, when the shaft 1200 is used in conjunction with a manual orhand held surgical instrument, the control members 1320 may betranslated distally and proximally in a manner similar to that describedherein above with respect to the reciprocating tubular actuating member58 of the instrument 10 and/or the axially moving member 378 of theinstrument 300. Also, for example, when the shaft 1300 is used inconjunction with a surgical robot, the control members 1320 may betranslated distally and proximally in a manner similar to that describedabove with respect to the tissue cutting element 555 of the instrument310. In certain embodiments, however, the spring 1310 may be omitted.For example, both proximal and distal force may be provided to the outershaft 1302 by the reciprocating control members.

FIG. 79 illustrates a cut-away view of one embodiment of the shaft 1300.FIG. 79 shows additional features of the inner shaft 1322. For example,the inner shaft 1322 may define a slot 1324 which may also receive theflange 1305. The slot 1324 may have an area larger than that of the slot1312. For example, the flange 1305 may not contact the edges of the slot1324 during normal operation. FIG. 80 illustrates the cut-away view ofone embodiment of the shaft 1300, with the outer shaft 1302 extendeddistally to articulate the blade 1303. As illustrated, a distal edge1313 of the slot 1312 contacts the flange 1305 pushing it distally inthe direction of arrow 1311. This, in turn, causes the blade 1303 andflange 1305 to pivot (at bendable waveguide portion 1316) to theposition shown.

FIG. 81 illustrates one embodiment of the shaft 1300 having anadditional distal flange 1307. The flange 1307 may extend substantiallyopposite the flange 1305. To prevent interference with articulation, theouter and inner shafts 1302, 1322 may define additional slots 1330, 1332of a size sufficient such that the flange 1307 does not contact anyedges of the slots 1330, 1332 during articulation. Also, althougharticulation in the described embodiment is provided by distal andproximal translation of the outer shaft 1302, it will be appreciatedthat similar shafts may be constructed having a reciprocating innerslotted shaft to perform the function provided by the outer shaft 1302as described herein. For example, the inner shaft may be translatablewithin an outer shaft and may define a slot for receiving the flange1305. As the inner shaft translates distally, its slot may contact theflange 1305, causing the blade 1303 to articulate, as shown in FIG. 80.

NON-LIMITING EXAMPLES

Various embodiments are directed to articulatable surgical instrumentscomprising an end effector comprising an ultrasonic blade, a hollowshaft extending proximally from the end effector along a longitudinalaxis and a waveguide extending through the shaft and acousticallycoupled to the ultrasonic blade. In certain embodiments, the waveguidecomprises a distally positioned flange positioned within the hollowshaft proximally from the blade. The waveguide may also be heldstationary at a first pivot point positioned within the hollow shaftproximally from the flange. A reciprocating wedge may be positionedwithin the hollow shaft such that distal motion of the wedge pushes thewedge between the flange and the hollow shaft, causing the ultrasonicblade to pivot about the first pivot in a first direction.

In certain embodiments, the hollow shaft may comprise a first shaftdefining a slot and a second shaft. The first and second shafts may betranslatable relative to one another along the longitudinal axis. Thewaveguide may comprise a distally positioned first flange positionedwithin the hollow shaft proximally from the blade, a bendable portionpositioned proximally from the first flange, and a second flangepositioned proximally from the bendable portion and fixedly coupled tothe second shaft. The first flange may extend through the slot. Also,the first shaft may be translatable from a distal position where aproximal edge of the slot pushes the first flange distally, bending theultrasonic blade away from the longitudinal axis to a proximal position.

In certain embodiments, an interior portion of the hollow shaft definesa shaft cam feature directed towards the longitudinal axis. Further, thewaveguide may define a waveguide cam feature directed away from thelongitudinal axis. In this way, rotation of the hollow shaft relative tothe waveguide causes the shaft cam feature to come into contact with thewaveguide cam feature, resulting in bending of the waveguide andultrasonic blade away from the longitudinal axis about the first pivotpoint in a first direction. In certain embodiments, the end effectorcomprises a clamp arm coupled to a member positioned around theultrasonic blade. The clamp arm may be pivotably coupled to the memberat a pivot point. A flexible control cable may be coupled to the clamparm at a point offset from the pivot point. Distal and proximaltranslation of the control cable may cause the clamp arm to pivotrelative to the ultrasonic blade. In certain embodiments, the member maydefine a threaded hole through which extends a flexible, threaded cable.The cable may also be coupled to the clamp arm such that rotation of thecable causes it to translate proximally and distally, depending on thedirection of rotation. Such proximally and distal translation may causethe clamp arm to open and close.

Also, various embodiments are directed to articulatable surgicalinstruments comprising an end effector comprising an ultrasonic bladeand a hollow shaft extending proximally from the end effector. Aninterior wall of the hollow shaft may define a groove, where differentpositions of the groove are positioned at different axial distances fromthe end effector. A first interface member may be coupled to either awaveguide or the ultrasonic blade at a coupling point and extendingproximally. The first interface member may comprise a first peg memberpositioned within the groove. A second interface member may be coupledto the waveguide or the ultrasonic blade at the coupling point and mayextend proximally. The second interface member may also comprise a pegmember positioned within the groove. Upon rotation of the hollow shaftrelative to the waveguide, the first and second peg members maytranslate within the groove causing bending of the first and secondinterface members and deflection of the first and second interfacemembers away from the longitudinal axis.

Various embodiments are directed to articulatable surgical instrumentscomprising an end effector and a shaft extending proximally from the endeffector along a longitudinal axis. The shaft may comprise a proximaltube and a distal tube pivotably coupled to the proximal tube at a hingeinterface offset from the longitudinal axis. The distal tube maycomprise an axially directed peg member. The surgical instruments mayfurther comprise an inner rotatable member extending proximally throughat least a portion of the proximal tube and at least a portion of thedistal tube. The inner rotatable member may define a slanted slot suchthat the axially directed peg member rides at least partially within theslanted slot and such that rotation of the inner rotatable member in afirst direction pushes the peg member and distal tube distally androtation of the inner rotatable member in a second direction oppositethe first direction pushes the peg member and distal tube proximally.

Applicant also owns the following patent applications that are eachincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 13/536,271, filed on Jun. 28, 2012 andentitled “Flexible Drive Member,” now U.S. Patent ApplicationPublication No. 2014-0005708 A1;

U.S. patent application Ser. No. 13/536,288, filed on Jun. 28, 2012 andentitled “Multi-Functional Powered Surgical Device with ExternalDissection Features,” now U.S. Patent Application Publication No.2014-0005718 A1;

U.S. patent application Ser. No. 13/536,295, filed on Jun. 28, 2012 andentitled “Rotary Actuatable Closure Arrangement for Surgical EndEffector,” now U.S. Patent Application Publication No. 2014-0005676 A1;

U.S. patent application Ser. No. 13/536,326, filed on Jun. 28, 2012 andentitled “Surgical End Effectors Having Angled Tissue-ContactingSurfaces,” now U.S. Patent Application Publication No. 2014-0005653 A1;

U.S. patent application Ser. No. 13/536,303, filed on Jun. 28, 2012 andentitled “Interchangeable End Effector Coupling Arrangement,” now U.S.Patent No. 9,028,494;

U.S. patent application Ser. No. 13/536,393, filed on Jun. 28, 2012 andentitled “Surgical End Effector Jaw and Electrode Configurations,” nowU.S. Patent Application Publication No. 2014-0005640 A1;

U.S. patent application Ser. No. 13/536,362, filed on Jun. 28, 2012 andentitled “Multi-Axis Articulating and Rotating Surgical Tools,” now U.S.Patent Application Publication No. 2014-0005662 A1; and

U.S. patent application Ser. No. 13/536,417, filed on Jun. 28, 2012 andentitled “Electrode Connections for Rotary Driven Surgical Tools,” nowU.S. Patent Application Publication No. 2014-0005680 A1.

It will be appreciated that the terms “proximal” and “distal” are usedthroughout the specification with reference to a clinician manipulatingone end of an instrument used to treat a patient. The term “proximal”refers to the portion of the instrument closest to the clinician and theterm “distal” refers to the portion located furthest from the clinician.It will further be appreciated that for conciseness and clarity, spatialterms such as “vertical,” “horizontal,” “up,” or “down” may be usedherein with respect to the illustrated embodiments. However, surgicalinstruments may be used in many orientations and positions, and theseterms are not intended to be limiting or absolute.

Various embodiments of surgical instruments and robotic surgical systemsare described herein. It will be understood by those skilled in the artthat the various embodiments described herein may be used with thedescribed surgical instruments and robotic surgical systems. Thedescriptions are provided for example only, and those skilled in the artwill understand that the disclosed embodiments are not limited to onlythe devices disclosed herein, but may be used with any compatiblesurgical instrument or robotic surgical system.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one example embodiment,” or “an embodiment” means that aparticular feature, structure, or characteristic described in connectionwith the embodiment is included in at least one example embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one example embodiment,” or “in an embodiment” inplaces throughout the specification are not necessarily all referring tothe same embodiment. Furthermore, the particular features, structures,or characteristics illustrated or described in connection with oneexample embodiment may be combined, in whole or in part, with features,structures, or characteristics of one or more other embodiments withoutlimitation.

While various embodiments herein have been illustrated by description ofseveral embodiments and while the illustrative embodiments have beendescribed in considerable detail, it is not the intention of theapplicant to restrict or in any way limit the scope of the appendedclaims to such detail. Additional advantages and modifications mayreadily appear to those skilled in the art. For example, each of thedisclosed embodiments may be employed in endoscopic procedures are,laparoscopic procedures, as well as open procedures, without limitationsto its intended use.

It is to be understood that at least some of the figures anddescriptions herein have been simplified to illustrate elements that arerelevant for a clear understanding of the disclosure, while eliminating,for purposes of clarity, other elements. Those of ordinary skill in theart will recognize, however, that these and other elements may bedesirable. However, because such elements are well known in the art, andbecause they do not facilitate a better understanding of the disclosure,a discussion of such elements is not provided herein.

While several embodiments have been described, it should be apparent,however, that various modifications, alterations and adaptations tothose embodiments may occur to persons skilled in the art with theattainment of some or all of the advantages of the disclosure. Forexample, according to various embodiments, a single component may bereplaced by multiple components, and multiple components may be replacedby a single component, to perform a given function or functions. Thisapplication is therefore intended to cover all such modifications,alterations and adaptations without departing from the scope and spiritof the disclosure as defined by the appended claims.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. An articulatable surgical instrument comprising:an end effector to treat tissue, wherein the end effector comprises anultrasonic blade; a hollow shaft extending proximally from the endeffector along a longitudinal axis, the hollow shaft having an exteriorwall and an interior wall, wherein the interior wall defines a groovewithin the hollow shaft, wherein the groove is parallel to a plane thatintersects the longitudinal axis, and wherein the groove comprises afirst position and a second position proximal from the first position; awaveguide acoustically coupled to the ultrasonic blade and extendingproximally through the hollow shaft; a first interface member coupled toeither the waveguide or the ultrasonic blade at a coupling point andextending proximally, wherein the first interface member comprises afirst peg member positioned within the groove; and a second interfacemember coupled to either the waveguide or the ultrasonic blade at thecoupling point and extending proximally, wherein the second interfacemember comprises a second peg member positioned within the groove, andwherein upon rotation of the hollow shaft relative to the waveguide, thefirst and second peg members translate within the groove, causingbending of the first and second interface members and deflection of thefirst and second interface members away from the longitudinal axis. 2.The surgical instrument of claim 1, wherein the first interface memberhas a first length between the first peg member and the coupling point,and wherein the second interface member has a second length between thesecond peg member and the coupling point less than the first length. 3.The surgical instrument of claim 1, wherein shifting of the first andsecond peg members within the groove causes distal translation of thefirst interface member and proximal translation of the second interfacemember, resulting in pivoting of the waveguide and the ultrasonic bladeaway from the longitudinal axis towards the second interface member. 4.The surgical instrument of claim 1, wherein the coupling pointcorresponds to an ultrasonic node at a resonant frequency of thewaveguide and the ultrasonic blade.
 5. The surgical instrument of claim1, wherein the waveguide comprises a bendable portion.
 6. The surgicalinstrument of claim 5, wherein, at at least one position on the bendableportion, the bendable portion comprises a cross sectional width and across-sectional length that is less than the cross sectional width. 7.An articulatable surgical instrument comprising: an ultrasonic bladehaving a tip; a shaft extending proximally from the ultrasonic bladealong a longitudinal axis, wherein the shaft comprises an exterior wallsurface and an interior wall surface, wherein the interior wall surfacecomprises a groove positioned at least partially about the longitudinalaxis, and wherein the groove has a first position that is proximal fromthe tip by a first distance and a second position that is proximal fromthe tip by a second distance greater than the first distance; and aninterface member, wherein the interface member comprises a distal endcoupled to the ultrasonic blade at a position proximal from the tip anda proximal end, and wherein the proximal end comprises a peg positionedin the groove, and wherein the shaft is rotatable relative to theultrasonic blade to move the peg from the first position in the grooveto the second position in the groove to move the interface memberproximally and articulate the ultrasonic blade towards the interfacemember.
 8. The surgical instrument of claim 7, further comprising asecond interface member, wherein the second interface member comprises asecond distal end and a second proximal end, the second distal endcoupled to the ultrasonic blade opposite the distal end of the interfacemember at a second position proximal from the tip.
 9. The surgicalinstrument of claim 7, further comprising a second interface member,wherein the second interface member comprises a second distal end and asecond proximal end, the second distal end coupled to the ultrasonicblade opposite the distal end of the interface member at a secondposition proximal from the tip, and wherein the second proximal endcomprises a second peg positioned in the groove.
 10. The surgicalinstrument of claim 7, further comprising a second interface member,wherein the second interface member comprises a second distal end and asecond proximal end, the second distal end coupled to the ultrasonicblade opposite the distal end of the interface member at a secondposition proximal from the tip, and the second proximal end comprising asecond peg positioned in the groove, and wherein, when the peg is at thefirst position, the second peg is at the second position.
 11. Thesurgical instrument of claim 7, further comprising a second interfacemember, wherein the second interface member comprises a second distalend and a second proximal end, the second distal end coupled to theultrasonic blade opposite the distal end of the interface member at asecond position proximal from the tip, and wherein the second interfacemember is longer than the interface member.
 12. The surgical instrumentof claim 7, wherein the ultrasonic blade is coupled to a waveguideextending proximally through the shaft, and wherein the waveguidecomprises a bendable portion.
 13. The surgical instrument of claim 12,wherein, at at least one position on the bendable portion, the bendableportion comprises a cross sectional width and a cross-sectional lengththat is less than the cross sectional width.
 14. The surgical instrumentof claim 7, wherein the ultrasonic blade comprises a flange, and whereinthe position proximal from the tip is at the flange.
 15. The surgicalinstrument of claim 7, wherein the groove extends completely around thelongitudinal axis.
 16. The surgical instrument of claim 7, wherein thegroove is an ovaloid.
 17. The surgical instrument of claim 7, whereinthe groove is parallel to a cross-section of the shaft in a plane thatintersects the longitudinal axis, and wherein the plane is notperpendicular to the longitudinal axis.
 18. The surgical instrument ofclaim 7, wherein the first position is at an ultrasonic node at aresonant frequency of the ultrasonic blade.
 19. A method of articulatingthe surgical instrument of claim 7, the method comprising rotating theshaft relative to the ultrasonic blade from a first shaft position inwhich the peg is at the first position in the groove to a second shaftposition in which the peg is at the second position in the groove.